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TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 401k Plan overview

Plan NameTJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN
Plan identification number 003

TJ SAMSON COMMUNITY HOSPITAL 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.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan covering Self-Employed individuals.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

T.J. SAMSON COMMUNITY HOSPITAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:T.J. SAMSON COMMUNITY HOSPITAL, INC.
Employer identification number (EIN):610461767
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032022-01-01
0032021-01-01
0032020-01-01
0032019-01-01
0032018-01-01
0032017-01-01MEI DENG MEI DENG2018-09-27
0032016-01-01MEI DENG MEI DENG2017-10-04
0032015-01-01BUD WETHINGTON BUD WETHINGTON2016-10-17
0032014-01-01STEPHEN FISCHER STEPHEN FISCHER2015-09-18
0032013-01-01STEPHEN FISCHER STEPHEN FISCHER2014-12-19
0032012-01-01STEPHEN FISCHER STEPHEN FISCHER2014-12-19
0032011-01-01STEPHEN FISCHER STEPHEN FISCHER2014-12-19

Plan Statistics for TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN

401k plan membership statisitcs for TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN

Measure Date Value
2022: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-011,471
Total number of active participants reported on line 7a of the Form 55002022-01-011,378
Number of retired or separated participants receiving benefits2022-01-012
Number of other retired or separated participants entitled to future benefits2022-01-01163
Total of all active and inactive participants2022-01-011,543
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-014
Total participants2022-01-011,547
Number of participants with account balances2022-01-011,496
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,399
Total number of active participants reported on line 7a of the Form 55002021-01-011,324
Number of retired or separated participants receiving benefits2021-01-011
Number of other retired or separated participants entitled to future benefits2021-01-01160
Total of all active and inactive participants2021-01-011,485
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-013
Total participants2021-01-011,488
Number of participants with account balances2021-01-011,443
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-013
2020: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011,387
Total number of active participants reported on line 7a of the Form 55002020-01-011,301
Number of retired or separated participants receiving benefits2020-01-011
Number of other retired or separated participants entitled to future benefits2020-01-01108
Total of all active and inactive participants2020-01-011,410
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-012
Total participants2020-01-011,412
Number of participants with account balances2020-01-011,364
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-019
2019: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011,307
Total number of active participants reported on line 7a of the Form 55002019-01-011,296
Number of retired or separated participants receiving benefits2019-01-012
Number of other retired or separated participants entitled to future benefits2019-01-0186
Total of all active and inactive participants2019-01-011,384
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-012
Total participants2019-01-011,386
Number of participants with account balances2019-01-011,339
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-0113
2018: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-011,261
Total number of active participants reported on line 7a of the Form 55002018-01-011,252
Number of retired or separated participants receiving benefits2018-01-012
Number of other retired or separated participants entitled to future benefits2018-01-0171
Total of all active and inactive participants2018-01-011,325
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-014
Total participants2018-01-011,329
Number of participants with account balances2018-01-01880
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-0116
2017: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-011,352
Total number of active participants reported on line 7a of the Form 55002017-01-011,236
Number of retired or separated participants receiving benefits2017-01-011
Number of other retired or separated participants entitled to future benefits2017-01-0149
Total of all active and inactive participants2017-01-011,286
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-011
Total participants2017-01-011,287
Number of participants with account balances2017-01-01765
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-0135
2016: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,189
Total number of active participants reported on line 7a of the Form 55002016-01-011,330
Number of retired or separated participants receiving benefits2016-01-011
Number of other retired or separated participants entitled to future benefits2016-01-0133
Total of all active and inactive participants2016-01-011,364
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-012
Total participants2016-01-011,366
Number of participants with account balances2016-01-01678
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-0126
2015: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,157
Total number of active participants reported on line 7a of the Form 55002015-01-011,146
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0138
Total of all active and inactive participants2015-01-011,184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-011,184
Number of participants with account balances2015-01-01614
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-0128
2014: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,145
Total number of active participants reported on line 7a of the Form 55002014-01-011,141
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0122
Total of all active and inactive participants2014-01-011,163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-011,163
Number of participants with account balances2014-01-01554
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-0116
2013: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,067
Total number of active participants reported on line 7a of the Form 55002013-01-011,078
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0114
Total of all active and inactive participants2013-01-011,092
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-011,092
Number of participants with account balances2013-01-01406
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-0153
2012: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,082
Total number of active participants reported on line 7a of the Form 55002012-01-011,098
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-016
Total of all active and inactive participants2012-01-011,104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-011,104
Number of participants with account balances2012-01-01350
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-0130
2011: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,052
Total number of active participants reported on line 7a of the Form 55002011-01-011,079
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-013
Total of all active and inactive participants2011-01-011,082
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-011,082
Number of participants with account balances2011-01-01305
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-0117

Financial Data on TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN

Measure Date Value
2022 : TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-1,119,317
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$4,387,787
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$4,216,369
Expenses. Certain deemed distributions of participant loans2022-12-31$5,550
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$8,144,025
Value of total assets at end of year2022-12-31$53,001,954
Value of total assets at beginning of year2022-12-31$58,509,058
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$165,868
Total interest from all sources2022-12-31$80,220
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$804,779
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$804,779
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$1,500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$5,034,095
Participant contributions at end of year2022-12-31$842,385
Participant contributions at beginning of year2022-12-31$877,890
Participant contributions at beginning of year2022-12-31$73
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$326,974
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-31$461
Other income not declared elsewhere2022-12-31$2,485
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-5,507,104
Value of net assets at end of year (total assets less liabilities)2022-12-31$53,001,954
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$58,509,058
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$50,242,425
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$55,973,618
Interest on participant loans2022-12-31$52,460
Interest earned on other investments2022-12-31$27,760
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$1,917,144
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$1,657,477
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-10,150,826
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$2,782,956
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$4,215,908
Contract administrator fees2022-12-31$165,868
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Disclaimer
Accountancy firm name2022-12-31TAYLOR POLSON & CO CPA PSC
Accountancy firm EIN2022-12-31611305816
2021 : TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$14,232,908
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$2,372,685
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$2,344,795
Value of total corrective distributions2021-12-31$968
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$7,345,030
Value of total assets at end of year2021-12-31$58,509,058
Value of total assets at beginning of year2021-12-31$46,648,835
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$26,922
Total interest from all sources2021-12-31$77,354
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$470,741
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$470,741
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$1,500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$4,501,004
Participant contributions at end of year2021-12-31$877,890
Participant contributions at beginning of year2021-12-31$782,623
Participant contributions at end of year2021-12-31$73
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$310,157
Other income not declared elsewhere2021-12-31$882
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$11,860,223
Value of net assets at end of year (total assets less liabilities)2021-12-31$58,509,058
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$46,648,835
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$55,973,618
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$44,712,126
Interest on participant loans2021-12-31$49,904
Interest earned on other investments2021-12-31$27,450
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$1,657,477
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$1,154,086
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$6,338,901
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$2,533,869
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$2,344,795
Contract administrator fees2021-12-31$26,922
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31TAYLOR POLSON & CO CPA PSC
Accountancy firm EIN2021-12-31611305816
2020 : TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2020 401k financial data
Unrealized appreciation/depreciation of real estate assets2020-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$0
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total transfer of assets to this plan2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$12,189,845
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$4,169,409
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$4,148,758
Expenses. Certain deemed distributions of participant loans2020-12-31$0
Value of total corrective distributions2020-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$5,942,546
Value of total assets at end of year2020-12-31$46,648,835
Value of total assets at beginning of year2020-12-31$38,628,399
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$20,651
Total income from rents2020-12-31$0
Total interest from all sources2020-12-31$73,569
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$488,559
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$488,559
Administrative expenses professional fees incurred2020-12-31$0
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$1,500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Amount of non-exempt transactions with any party-in-interest2020-12-31$0
Contributions received from participants2020-12-31$3,715,327
Participant contributions at end of year2020-12-31$782,623
Participant contributions at beginning of year2020-12-31$730,195
Participant contributions at end of year2020-12-31$0
Participant contributions at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$45,904
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$0
Other income not declared elsewhere2020-12-31$-4,766
Administrative expenses (other) incurred2020-12-31$0
Liabilities. Value of operating payables at beginning of year2020-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$8,020,436
Value of net assets at end of year (total assets less liabilities)2020-12-31$46,648,835
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$38,628,399
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
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 year2020-12-31$0
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2020-12-31$0
Investment advisory and management fees2020-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$44,712,126
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$36,556,268
Interest on participant loans2020-12-31$51,049
Income. Interest from loans (other than to participants)2020-12-31$0
Interest earned on other investments2020-12-31$22,520
Income. Interest from US Government securities2020-12-31$0
Income. Interest from corporate debt instruments2020-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$1,154,086
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$1,341,936
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$5,689,937
Net investment gain/loss from pooled separate accounts2020-12-31$0
Net investment gain or loss from common/collective trusts2020-12-31$0
Net gain/loss from 103.12 investment entities2020-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$2,181,315
Employer contributions (assets) at end of year2020-12-31$0
Employer contributions (assets) at beginning of year2020-12-31$0
Income. Dividends from preferred stock2020-12-31$0
Income. Dividends from common stock2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$4,148,758
Contract administrator fees2020-12-31$20,651
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$0
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Aggregate proceeds on sale of assets2020-12-31$0
Aggregate carrying amount (costs) on sale of assets2020-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2020-12-31$0
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31TAYLOR POLSON & CO CPA PSC
Accountancy firm EIN2020-12-31611305816
2019 : TJ SAMSON COMMUNITY HOSPITAL 403(B) 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 to 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$11,733,085
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$1,984,530
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$1,966,435
Expenses. Certain deemed distributions of participant loans2019-12-31$0
Value of total corrective distributions2019-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$5,617,061
Value of total assets at end of year2019-12-31$38,628,399
Value of total assets at beginning of year2019-12-31$28,879,844
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$18,095
Total income from rents2019-12-31$0
Total interest from all sources2019-12-31$62,776
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$451,897
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$451,897
Administrative expenses professional fees incurred2019-12-31$0
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$1,500,000
If this is an individual account plan, was there a blackout period2019-12-31No
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
Amount of non-exempt transactions with any party-in-interest2019-12-31$0
Contributions received from participants2019-12-31$3,491,481
Participant contributions at end of year2019-12-31$730,195
Participant contributions at beginning of year2019-12-31$482,395
Participant contributions at end of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$207,480
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$0
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 beginning of year2019-12-31$0
Other income not declared elsewhere2019-12-31$0
Administrative expenses (other) incurred2019-12-31$0
Liabilities. Value of operating payables at beginning of year2019-12-31$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$9,748,555
Value of net assets at end of year (total assets less liabilities)2019-12-31$38,628,399
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$28,879,844
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
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 year2019-12-31$0
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2019-12-31$0
Investment advisory and management fees2019-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$36,556,268
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$27,399,152
Interest on participant loans2019-12-31$40,705
Income. Interest from loans (other than to participants)2019-12-31$0
Interest earned on other investments2019-12-31$22,071
Income. Interest from US Government securities2019-12-31$0
Income. Interest from corporate debt instruments2019-12-31$0
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$1,341,936
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$998,297
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$5,601,351
Net investment gain/loss from pooled separate accounts2019-12-31$0
Net investment gain or loss from common/collective trusts2019-12-31$0
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 contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$1,918,100
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$0
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$1,966,435
Contract administrator fees2019-12-31$18,095
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
Liabilities. Value of acquisition indebtedness at beginning of year2019-12-31$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 name2019-12-31TAYLOR, POLSON, & COMPANY, PSC
Accountancy firm EIN2019-12-31611305816
2018 : TJ SAMSON COMMUNITY HOSPITAL 403(B) 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 transfer of assets to this plan2018-12-31$10,886
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$3,505,537
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$1,386,450
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$1,368,983
Expenses. Certain deemed distributions of participant loans2018-12-31$2,987
Value of total corrective distributions2018-12-31$3,727
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$4,943,548
Value of total assets at end of year2018-12-31$28,879,844
Value of total assets at beginning of year2018-12-31$26,749,871
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$10,753
Total income from rents2018-12-31$0
Total interest from all sources2018-12-31$41,440
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$349,627
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$349,627
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$1,500,000
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
Amount of non-exempt transactions with any party-in-interest2018-12-31$0
Contributions received from participants2018-12-31$3,082,174
Participant contributions at end of year2018-12-31$482,395
Participant contributions at beginning of year2018-12-31$350,169
Participant contributions at end of year2018-12-31$0
Participant contributions at beginning of year2018-12-31$95,581
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$213,937
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 beginning of year2018-12-31$0
Other income not declared elsewhere2018-12-31$0
Administrative expenses (other) incurred2018-12-31$0
Liabilities. Value of operating payables at beginning of year2018-12-31$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
Value of net income/loss2018-12-31$2,119,087
Value of net assets at end of year (total assets less liabilities)2018-12-31$28,879,844
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$26,749,871
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
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 year2018-12-31$0
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2018-12-31$0
Investment advisory and management fees2018-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$27,399,152
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$25,439,590
Interest on participant loans2018-12-31$26,167
Income. Interest from loans (other than to participants)2018-12-31$0
Interest earned on other investments2018-12-31$15,273
Income. Interest from US Government securities2018-12-31$0
Income. Interest from corporate debt instruments2018-12-31$0
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$998,297
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$812,498
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-1,829,078
Net investment gain/loss from pooled separate accounts2018-12-31$0
Net investment gain or loss from common/collective trusts2018-12-31$0
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 contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$1,647,437
Employer contributions (assets) at end of year2018-12-31$0
Employer contributions (assets) at beginning of year2018-12-31$52,033
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$1,368,983
Contract administrator fees2018-12-31$10,753
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
Liabilities. Value of acquisition indebtedness at beginning of year2018-12-31$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 name2018-12-31TAYLOR, POLSON & COMPANY, PSC
Accountancy firm EIN2018-12-31611305816
2017 : TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2017 401k financial data
Unrealized appreciation/depreciation of real estate assets2017-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2017-12-31$0
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total transfer of assets to this plan2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$8,277,696
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$1,194,355
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$1,161,455
Expenses. Certain deemed distributions of participant loans2017-12-31$0
Value of total corrective distributions2017-12-31$21,938
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$4,668,159
Value of total assets at end of year2017-12-31$26,749,871
Value of total assets at beginning of year2017-12-31$19,666,530
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$10,962
Total income from rents2017-12-31$0
Total interest from all sources2017-12-31$29,908
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$275,625
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$275,625
Administrative expenses professional fees incurred2017-12-31$0
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$1,500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Amount of non-exempt transactions with any party-in-interest2017-12-31$0
Contributions received from participants2017-12-31$2,914,116
Participant contributions at end of year2017-12-31$350,169
Participant contributions at beginning of year2017-12-31$255,766
Participant contributions at end of year2017-12-31$95,581
Participant contributions at beginning of year2017-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$223,280
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2017-12-31$2,415
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$0
Other income not declared elsewhere2017-12-31$0
Administrative expenses (other) incurred2017-12-31$0
Liabilities. Value of operating payables at beginning of year2017-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$7,083,341
Value of net assets at end of year (total assets less liabilities)2017-12-31$26,749,871
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$19,666,530
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
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 year2017-12-31$0
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2017-12-31$0
Investment advisory and management fees2017-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$25,439,590
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$18,687,252
Interest on participant loans2017-12-31$16,636
Income. Interest from loans (other than to participants)2017-12-31$0
Interest earned on other investments2017-12-31$13,272
Income. Interest from US Government securities2017-12-31$0
Income. Interest from corporate debt instruments2017-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$812,498
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$723,512
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$3,304,004
Net investment gain/loss from pooled separate accounts2017-12-31$0
Net investment gain or loss from common/collective trusts2017-12-31$0
Net gain/loss from 103.12 investment entities2017-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$1,530,763
Employer contributions (assets) at end of year2017-12-31$52,033
Employer contributions (assets) at beginning of year2017-12-31$0
Income. Dividends from preferred stock2017-12-31$0
Income. Dividends from common stock2017-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$1,159,040
Contract administrator fees2017-12-31$10,962
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$0
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Aggregate proceeds on sale of assets2017-12-31$0
Aggregate carrying amount (costs) on sale of assets2017-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2017-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31TAYLOR POLSON & CO CPA PSC
Accountancy firm EIN2017-12-31611305816
2016 : TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2016 401k financial data
Unrealized appreciation/depreciation of real estate assets2016-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2016-12-31$0
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total transfer of assets to this plan2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$5,622,554
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$1,030,577
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$966,923
Expenses. Certain deemed distributions of participant loans2016-12-31$0
Value of total corrective distributions2016-12-31$46,339
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$4,591,665
Value of total assets at end of year2016-12-31$19,666,530
Value of total assets at beginning of year2016-12-31$15,074,553
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$17,315
Total income from rents2016-12-31$0
Total interest from all sources2016-12-31$20,962
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$247,196
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$247,196
Administrative expenses professional fees incurred2016-12-31$0
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$1,500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Amount of non-exempt transactions with any party-in-interest2016-12-31$0
Contributions received from participants2016-12-31$2,679,333
Participant contributions at end of year2016-12-31$255,766
Participant contributions at beginning of year2016-12-31$240,125
Participant contributions at end of year2016-12-31$0
Participant contributions at beginning of year2016-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$771,203
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$0
Other income not declared elsewhere2016-12-31$0
Administrative expenses (other) incurred2016-12-31$0
Liabilities. Value of operating payables at beginning of year2016-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$4,591,977
Value of net assets at end of year (total assets less liabilities)2016-12-31$19,666,530
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$15,074,553
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
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 year2016-12-31$0
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2016-12-31$0
Investment advisory and management fees2016-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$18,687,252
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$14,162,056
Interest on participant loans2016-12-31$13,285
Income. Interest from loans (other than to participants)2016-12-31$0
Interest earned on other investments2016-12-31$7,677
Income. Interest from US Government securities2016-12-31$0
Income. Interest from corporate debt instruments2016-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$723,512
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$672,372
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$762,731
Net investment gain/loss from pooled separate accounts2016-12-31$0
Net investment gain or loss from common/collective trusts2016-12-31$0
Net gain/loss from 103.12 investment entities2016-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$1,141,129
Employer contributions (assets) at end of year2016-12-31$0
Employer contributions (assets) at beginning of year2016-12-31$0
Income. Dividends from preferred stock2016-12-31$0
Income. Dividends from common stock2016-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$966,923
Contract administrator fees2016-12-31$17,315
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$0
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Aggregate proceeds on sale of assets2016-12-31$0
Aggregate carrying amount (costs) on sale of assets2016-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2016-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31TAYLOR, POLSON & COMPANY, PSC
Accountancy firm EIN2016-12-31611305816
2015 : TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets2015-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2015-12-31$0
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total transfer of assets to this plan2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$3,709,592
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$2,725,677
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$2,691,794
Expenses. Certain deemed distributions of participant loans2015-12-31$0
Value of total corrective distributions2015-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$3,920,625
Value of total assets at end of year2015-12-31$15,074,553
Value of total assets at beginning of year2015-12-31$14,090,638
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$33,883
Total income from rents2015-12-31$0
Total interest from all sources2015-12-31$19,037
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$143,986
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$143,986
Administrative expenses professional fees incurred2015-12-31$0
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$1,500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Amount of non-exempt transactions with any party-in-interest2015-12-31$0
Contributions received from participants2015-12-31$2,524,767
Participant contributions at end of year2015-12-31$240,125
Participant contributions at beginning of year2015-12-31$207,651
Participant contributions at end of year2015-12-31$0
Participant contributions at beginning of year2015-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$304,827
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$0
Other income not declared elsewhere2015-12-31$0
Administrative expenses (other) incurred2015-12-31$0
Liabilities. Value of operating payables at beginning of year2015-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$983,915
Value of net assets at end of year (total assets less liabilities)2015-12-31$15,074,553
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$14,090,638
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
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 year2015-12-31$0
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2015-12-31$0
Investment advisory and management fees2015-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$14,162,056
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$13,306,018
Interest on participant loans2015-12-31$11,092
Income. Interest from loans (other than to participants)2015-12-31$0
Interest earned on other investments2015-12-31$7,945
Income. Interest from US Government securities2015-12-31$0
Income. Interest from corporate debt instruments2015-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$672,372
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$576,969
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-374,056
Net investment gain/loss from pooled separate accounts2015-12-31$0
Net investment gain or loss from common/collective trusts2015-12-31$0
Net gain/loss from 103.12 investment entities2015-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$1,091,031
Employer contributions (assets) at end of year2015-12-31$0
Employer contributions (assets) at beginning of year2015-12-31$0
Income. Dividends from preferred stock2015-12-31$0
Income. Dividends from common stock2015-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$2,691,794
Contract administrator fees2015-12-31$33,883
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$0
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Aggregate proceeds on sale of assets2015-12-31$0
Aggregate carrying amount (costs) on sale of assets2015-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2015-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31TAYLOR, POLSON & COMPANY, PSC
Accountancy firm EIN2015-12-31611305816
2014 : TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2014 401k financial data
Unrealized appreciation/depreciation of real estate assets2014-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$0
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total transfer of assets to this plan2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$5,815,924
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$1,043,839
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$1,005,668
Expenses. Certain deemed distributions of participant loans2014-12-31$0
Value of total corrective distributions2014-12-31$11,475
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$5,272,152
Value of total assets at end of year2014-12-31$14,090,638
Value of total assets at beginning of year2014-12-31$9,318,553
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$26,696
Total income from rents2014-12-31$0
Total interest from all sources2014-12-31$15,996
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$251,245
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$251,245
Administrative expenses professional fees incurred2014-12-31$0
Was this plan covered by a fidelity bond2014-12-31No
Value of fidelity bond cover2014-12-31$0
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Amount of non-exempt transactions with any party-in-interest2014-12-31$0
Contributions received from participants2014-12-31$1,780,878
Participant contributions at end of year2014-12-31$207,651
Participant contributions at beginning of year2014-12-31$172,743
Participant contributions at end of year2014-12-31$0
Participant contributions at beginning of year2014-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$2,753,052
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$0
Other income not declared elsewhere2014-12-31$0
Administrative expenses (other) incurred2014-12-31$0
Liabilities. Value of operating payables at beginning of year2014-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$4,772,085
Value of net assets at end of year (total assets less liabilities)2014-12-31$14,090,638
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$9,318,553
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
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 year2014-12-31$0
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2014-12-31$0
Investment advisory and management fees2014-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$13,306,018
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$8,726,139
Interest on participant loans2014-12-31$9,704
Income. Interest from loans (other than to participants)2014-12-31$0
Interest earned on other investments2014-12-31$6,292
Income. Interest from US Government securities2014-12-31$0
Income. Interest from corporate debt instruments2014-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$576,969
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$419,671
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$276,531
Net investment gain/loss from pooled separate accounts2014-12-31$0
Net investment gain or loss from common/collective trusts2014-12-31$0
Net gain/loss from 103.12 investment entities2014-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$738,222
Employer contributions (assets) at end of year2014-12-31$0
Employer contributions (assets) at beginning of year2014-12-31$0
Income. Dividends from preferred stock2014-12-31$0
Income. Dividends from common stock2014-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$1,005,668
Contract administrator fees2014-12-31$26,696
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$0
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Aggregate proceeds on sale of assets2014-12-31$0
Aggregate carrying amount (costs) on sale of assets2014-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2014-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31TAYLOR POLSON
Accountancy firm EIN2014-12-31611305816
2013 : TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2013 401k financial data
Unrealized appreciation/depreciation of real estate assets2013-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$0
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total transfer of assets to this plan2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$3,109,468
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$292,142
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$250,550
Expenses. Certain deemed distributions of participant loans2013-12-31$0
Value of total corrective distributions2013-12-31$24,271
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$1,846,707
Value of total assets at end of year2013-12-31$9,318,553
Value of total assets at beginning of year2013-12-31$6,501,227
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$17,321
Total income from rents2013-12-31$0
Total interest from all sources2013-12-31$10,878
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$112,638
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$112,638
Administrative expenses professional fees incurred2013-12-31$0
Was this plan covered by a fidelity bond2013-12-31No
Value of fidelity bond cover2013-12-31$0
If this is an individual account plan, was there a blackout period2013-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Amount of non-exempt transactions with any party-in-interest2013-12-31$0
Contributions received from participants2013-12-31$1,335,659
Participant contributions at end of year2013-12-31$172,743
Participant contributions at beginning of year2013-12-31$101,283
Participant contributions at end of year2013-12-31$0
Participant contributions at beginning of year2013-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$102,976
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$0
Other income not declared elsewhere2013-12-31$0
Administrative expenses (other) incurred2013-12-31$0
Liabilities. Value of operating payables at beginning of year2013-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$2,817,326
Value of net assets at end of year (total assets less liabilities)2013-12-31$9,318,553
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$6,501,227
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
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 year2013-12-31$0
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2013-12-31$0
Investment advisory and management fees2013-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$8,726,139
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$6,042,769
Interest on participant loans2013-12-31$5,444
Income. Interest from loans (other than to participants)2013-12-31$0
Interest earned on other investments2013-12-31$5,434
Income. Interest from US Government securities2013-12-31$0
Income. Interest from corporate debt instruments2013-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$419,671
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$357,175
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$1,139,245
Net investment gain/loss from pooled separate accounts2013-12-31$0
Net investment gain or loss from common/collective trusts2013-12-31$0
Net gain/loss from 103.12 investment entities2013-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$408,072
Employer contributions (assets) at end of year2013-12-31$0
Employer contributions (assets) at beginning of year2013-12-31$0
Income. Dividends from preferred stock2013-12-31$0
Income. Dividends from common stock2013-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$250,550
Contract administrator fees2013-12-31$17,321
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$0
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Aggregate proceeds on sale of assets2013-12-31$0
Aggregate carrying amount (costs) on sale of assets2013-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2013-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31TAYLOR POLSON & COMPANY
Accountancy firm EIN2013-12-31611305816
2012 : TJ SAMSON COMMUNITY HOSPITAL 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$28,872
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
Total income from all sources (including contributions)2012-12-31$2,354,888
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$175,321
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$163,512
Expenses. Certain deemed distributions of participant loans2012-12-31$0
Value of total corrective distributions2012-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$1,702,492
Value of total assets at end of year2012-12-31$6,501,227
Value of total assets at beginning of year2012-12-31$4,292,788
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$11,809
Total income from rents2012-12-31$0
Total interest from all sources2012-12-31$8,878
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$97,625
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$97,625
Administrative expenses professional fees incurred2012-12-31$0
Was this plan covered by a fidelity bond2012-12-31No
Value of fidelity bond cover2012-12-31$0
If this is an individual account plan, was there a blackout period2012-12-31No
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$1,223,125
Participant contributions at end of year2012-12-31$101,283
Participant contributions at beginning of year2012-12-31$54,750
Participant contributions at end of year2012-12-31$0
Participant contributions at beginning of year2012-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$114,391
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
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
Value of net income/loss2012-12-31$2,179,567
Value of net assets at end of year (total assets less liabilities)2012-12-31$6,501,227
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$4,292,788
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$6,042,769
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$3,973,444
Interest on participant loans2012-12-31$3,229
Income. Interest from loans (other than to participants)2012-12-31$0
Interest earned on other investments2012-12-31$5,649
Income. Interest from US Government securities2012-12-31$0
Income. Interest from corporate debt instruments2012-12-31$0
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$357,175
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$264,594
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$545,893
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$364,976
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$163,512
Contract administrator fees2012-12-31$11,809
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 name2012-12-31TAYLOR, POLSON, & COMPANY, PSC
Accountancy firm EIN2012-12-31611305816
2011 : TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2011 401k financial data
Unrealized appreciation/depreciation of real estate assets2011-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$0
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total transfer of assets to this plan2011-12-31$0
Total transfer of assets from this plan2011-12-31$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$952,730
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$244,807
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$235,300
Expenses. Certain deemed distributions of participant loans2011-12-31$0
Value of total corrective distributions2011-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$1,051,586
Value of total assets at end of year2011-12-31$4,292,788
Value of total assets at beginning of year2011-12-31$3,584,865
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$9,507
Total income from rents2011-12-31$0
Total interest from all sources2011-12-31$7,907
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$64,666
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$64,666
Administrative expenses professional fees incurred2011-12-31$0
Was this plan covered by a fidelity bond2011-12-31No
Value of fidelity bond cover2011-12-31$0
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Amount of non-exempt transactions with any party-in-interest2011-12-31$0
Contributions received from participants2011-12-31$905,736
Participant contributions at end of year2011-12-31$54,750
Participant contributions at beginning of year2011-12-31$73,334
Participant contributions at end of year2011-12-31$0
Participant contributions at beginning of year2011-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$69,430
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$0
Other income not declared elsewhere2011-12-31$0
Administrative expenses (other) incurred2011-12-31$0
Liabilities. Value of operating payables at beginning of year2011-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$707,923
Value of net assets at end of year (total assets less liabilities)2011-12-31$4,292,788
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$3,584,865
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
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 year2011-12-31$0
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2011-12-31$0
Investment advisory and management fees2011-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$3,973,444
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$3,272,672
Interest on participant loans2011-12-31$2,970
Income. Interest from loans (other than to participants)2011-12-31$0
Interest earned on other investments2011-12-31$4,937
Income. Interest from US Government securities2011-12-31$0
Income. Interest from corporate debt instruments2011-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$264,594
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$238,859
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-171,429
Net investment gain/loss from pooled separate accounts2011-12-31$0
Net investment gain or loss from common/collective trusts2011-12-31$0
Net gain/loss from 103.12 investment entities2011-12-31$0
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
Contributions received in cash from employer2011-12-31$76,420
Employer contributions (assets) at end of year2011-12-31$0
Employer contributions (assets) at beginning of year2011-12-31$0
Income. Dividends from preferred stock2011-12-31$0
Income. Dividends from common stock2011-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$235,300
Contract administrator fees2011-12-31$9,507
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$0
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
Aggregate proceeds on sale of assets2011-12-31$0
Aggregate carrying amount (costs) on sale of assets2011-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2011-12-31$0
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 name2011-12-31TAYLOR AND POLSON
Accountancy firm EIN2011-12-31611305816
2010 : TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2010 401k financial data
Unrealized appreciation/depreciation of real estate assets2010-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2010-12-31$0
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total transfer of assets to this plan2010-12-31$2,660,880
Total transfer of assets from this plan2010-12-31$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$927,237
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$3,252
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$0
Expenses. Certain deemed distributions of participant loans2010-12-31$0
Value of total corrective distributions2010-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$550,252
Value of total assets at end of year2010-12-31$3,584,865
Value of total assets at beginning of year2010-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$3,252
Total income from rents2010-12-31$0
Total interest from all sources2010-12-31$3,417
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$46,043
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$46,043
Administrative expenses professional fees incurred2010-12-31$0
Was this plan covered by a fidelity bond2010-12-31No
Value of fidelity bond cover2010-12-31$0
If this is an individual account plan, was there a blackout period2010-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Amount of non-exempt transactions with any party-in-interest2010-12-31$0
Contributions received from participants2010-12-31$380,873
Participant contributions at end of year2010-12-31$73,334
Participant contributions at end of year2010-12-31$0
Participant contributions at beginning of year2010-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$169,379
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2010-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$0
Other income not declared elsewhere2010-12-31$0
Administrative expenses (other) incurred2010-12-31$0
Liabilities. Value of operating payables at beginning of year2010-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$923,985
Value of net assets at end of year (total assets less liabilities)2010-12-31$3,584,865
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$0
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
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 year2010-12-31$0
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2010-12-31$0
Investment advisory and management fees2010-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$3,272,672
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$0
Interest on participant loans2010-12-31$1,006
Income. Interest from loans (other than to participants)2010-12-31$0
Interest earned on other investments2010-12-31$2,411
Income. Interest from US Government securities2010-12-31$0
Income. Interest from corporate debt instruments2010-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$238,859
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$327,525
Net investment gain/loss from pooled separate accounts2010-12-31$0
Net investment gain or loss from common/collective trusts2010-12-31$0
Net gain/loss from 103.12 investment entities2010-12-31$0
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 contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$0
Employer contributions (assets) at end of year2010-12-31$0
Employer contributions (assets) at beginning of year2010-12-31$0
Income. Dividends from preferred stock2010-12-31$0
Income. Dividends from common stock2010-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$0
Contract administrator fees2010-12-31$3,252
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31Yes
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$0
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
Aggregate proceeds on sale of assets2010-12-31$0
Aggregate carrying amount (costs) on sale of assets2010-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2010-12-31$0

Form 5500 Responses for TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN

2022: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
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 – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
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 – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
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: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
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: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedYes
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: TJ SAMSON COMMUNITY HOSPITAL 403(B) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 2
Insurance contract or identification number613953
Number of Individuals Covered1547
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,591
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
Commission paid to Insurance BrokerUSD $2,591
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number711086
Policy instance 1
Insurance contract or identification number711086
Number of Individuals Covered1547
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $19
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
Commission paid to Insurance BrokerUSD $19
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 2
Insurance contract or identification number613953
Number of Individuals Covered1488
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,395
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
Commission paid to Insurance BrokerUSD $2,395
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number711086
Policy instance 1
Insurance contract or identification number711086
Number of Individuals Covered1488
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $22
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
Commission paid to Insurance BrokerUSD $22
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 2
Insurance contract or identification number613953
Number of Individuals Covered1412
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,954
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
Commission paid to Insurance BrokerUSD $1,954
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number711086
Policy instance 1
Insurance contract or identification number711086
Number of Individuals Covered1412
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $13
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
Commission paid to Insurance BrokerUSD $13
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 2
Insurance contract or identification number613953
Number of Individuals Covered1386
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,741
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
Commission paid to Insurance BrokerUSD $1,741
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number711086
Policy instance 1
Insurance contract or identification number711086
Number of Individuals Covered1386
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 2
Insurance contract or identification number613953
Number of Individuals Covered1287
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,125
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
Commission paid to Insurance BrokerUSD $1,125
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameJJB HILLIARD W L LYONS LLC
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number711086
Policy instance 1
Insurance contract or identification number711086
Number of Individuals Covered1287
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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
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 Covered1184
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,474
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
Commission paid to Insurance BrokerUSD $1,474
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameJJB HILLIARD W L LYONS LLC
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 Covered1163
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,096
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
Commission paid to Insurance BrokerUSD $1,096
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameJJB HILLIARD W L LYONS LLC
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 Covered1092
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $15,253
Total amount of fees paid to insurance companyUSD $2,355
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
Commission paid to Insurance BrokerUSD $15,253
Amount paid for insurance broker fees2355
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameJJB HILLIARD W L LYONS LLC
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 Covered1104
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $9,160
Total amount of fees paid to insurance companyUSD $337
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
Commission paid to Insurance BrokerUSD $9,160
Amount paid for insurance broker fees337
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameJJB HILLIARD W L LYONS LLC
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 Covered1082
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $8,527
Total amount of fees paid to insurance companyUSD $1,005
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
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 Covered1708
Insurance policy start date2010-07-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $27,445
Total amount of fees paid to insurance companyUSD $5,187
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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