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CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN 401k Plan overview

Plan NameCAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN
Plan identification number 001

CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY 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.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

CAVERNA MEMORIAL HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:CAVERNA MEMORIAL HOSPITAL
Employer identification number (EIN):610654135
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012015-07-01RONALD SOWELL
0012014-07-01ALAN ALEXANDER
0012013-07-01ALAN ALEXANDER
0012012-07-01ANNIE MIDDLETON ANNIE MIDDLETON2014-01-30
0012011-07-01ALAN ALEXANDER
0012009-07-01ALAN ALEXANDER

Financial Data on CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN

Measure Date Value
2015 : CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$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$96,190
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$3,422,557
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$3,422,557
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$182,145
Value of total assets at end of year2015-12-31$0
Value of total assets at beginning of year2015-12-31$3,326,367
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$0
Total interest from all sources2015-12-31$8,072
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2015-12-31$0
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$400,000
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
Contributions received from participants2015-12-31$119,783
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-12-31$2,876,947
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-3,326,367
Value of net assets at end of year (total assets less liabilities)2015-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$3,326,367
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
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$2,597,197
Interest earned on other investments2015-12-31$8,072
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$729,170
Net investment gain/loss from pooled separate accounts2015-12-31$-94,027
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 contributions2015-12-31Yes
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$62,362
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$545,610
Did the plan have assets held for investment2015-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31Yes
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 name2015-12-31BLUE & CO., LLC
Accountancy firm EIN2015-12-31351178661
Total unrealized appreciation/depreciation of assets2015-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$0
Total income from all sources (including contributions)2015-06-30$499,764
Total loss/gain on sale of assets2015-06-30$0
Total of all expenses incurred2015-06-30$334,766
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-06-30$334,766
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-06-30$351,332
Value of total assets at end of year2015-06-30$3,326,367
Value of total assets at beginning of year2015-06-30$3,161,369
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-06-30$0
Total interest from all sources2015-06-30$22,581
Total dividends received (eg from common stock, registered investment company shares)2015-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-06-30No
Was this plan covered by a fidelity bond2015-06-30Yes
Value of fidelity bond cover2015-06-30$400,000
If this is an individual account plan, was there a blackout period2015-06-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-06-30$0
Were there any nonexempt tranactions with any party-in-interest2015-06-30No
Contributions received from participants2015-06-30$243,523
Income. Received or receivable in cash from other sources (including rollovers)2015-06-30$217
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Value of net income/loss2015-06-30$164,998
Value of net assets at end of year (total assets less liabilities)2015-06-30$3,326,367
Value of net assets at beginning of year (total assets less liabilities)2015-06-30$3,161,369
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-06-30No
Were any leases to which the plan was party in default or uncollectible2015-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-06-30$2,597,197
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-06-30$2,301,332
Interest earned on other investments2015-06-30$22,581
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-06-30$729,170
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-06-30$852,470
Net investment gain/loss from pooled separate accounts2015-06-30$125,851
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-06-30No
Was there a failure to transmit to the plan any participant contributions2015-06-30No
Has the plan failed to provide any benefit when due under the plan2015-06-30No
Contributions received in cash from employer2015-06-30$107,592
Employer contributions (assets) at beginning of year2015-06-30$7,567
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-06-30$334,766
Did the plan have assets held for investment2015-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-06-30Yes
Opinion of an independent qualified public accountant for this plan2015-06-30Disclaimer
Accountancy firm name2015-06-30DEMING, MALONE, LIVESAY & OSTROFF
Accountancy firm EIN2015-06-30611064249
2014 : CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$0
Total income from all sources (including contributions)2014-06-30$719,494
Total loss/gain on sale of assets2014-06-30$0
Total of all expenses incurred2014-06-30$65,031
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-06-30$65,031
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-06-30$313,053
Value of total assets at end of year2014-06-30$3,161,369
Value of total assets at beginning of year2014-06-30$2,506,906
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-06-30$0
Total interest from all sources2014-06-30$23,609
Total dividends received (eg from common stock, registered investment company shares)2014-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-06-30No
Was this plan covered by a fidelity bond2014-06-30Yes
Value of fidelity bond cover2014-06-30$300,000
If this is an individual account plan, was there a blackout period2014-06-30No
Were there any nonexempt tranactions with any party-in-interest2014-06-30No
Contributions received from participants2014-06-30$208,912
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Value of net income/loss2014-06-30$654,463
Value of net assets at end of year (total assets less liabilities)2014-06-30$3,161,369
Value of net assets at beginning of year (total assets less liabilities)2014-06-30$2,506,906
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-06-30No
Were any leases to which the plan was party in default or uncollectible2014-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-06-30$2,301,332
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-06-30$1,773,592
Interest earned on other investments2014-06-30$23,609
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-06-30$852,470
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-06-30$733,314
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-06-30$382,832
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-06-30No
Was there a failure to transmit to the plan any participant contributions2014-06-30No
Has the plan failed to provide any benefit when due under the plan2014-06-30No
Contributions received in cash from employer2014-06-30$104,141
Employer contributions (assets) at end of year2014-06-30$7,567
Employer contributions (assets) at beginning of year2014-06-30$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-06-30$65,031
Did the plan have assets held for investment2014-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-06-30Yes
Opinion of an independent qualified public accountant for this plan2014-06-30Disclaimer
Accountancy firm name2014-06-30DEMING, MALONE, LIVESAY & OSTROFF
Accountancy firm EIN2014-06-30611064249
2013 : CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$0
Total income from all sources (including contributions)2013-06-30$627,940
Total loss/gain on sale of assets2013-06-30$0
Total of all expenses incurred2013-06-30$252,834
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-06-30$252,834
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-06-30$293,485
Value of total assets at end of year2013-06-30$2,506,906
Value of total assets at beginning of year2013-06-30$2,131,800
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-06-30$0
Total interest from all sources2013-06-30$17,999
Total dividends received (eg from common stock, registered investment company shares)2013-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-06-30No
Was this plan covered by a fidelity bond2013-06-30Yes
Value of fidelity bond cover2013-06-30$300,000
If this is an individual account plan, was there a blackout period2013-06-30No
Funding deficiency by the employer to the plan for this plan year2013-06-30$0
Minimum employer required contribution for this plan year2013-06-30$0
Amount contributed by the employer to the plan for this plan year2013-06-30$0
Were there any nonexempt tranactions with any party-in-interest2013-06-30No
Contributions received from participants2013-06-30$207,345
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Value of net income/loss2013-06-30$375,106
Value of net assets at end of year (total assets less liabilities)2013-06-30$2,506,906
Value of net assets at beginning of year (total assets less liabilities)2013-06-30$2,131,800
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-06-30No
Were any leases to which the plan was party in default or uncollectible2013-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-06-30$1,773,592
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-06-30$1,722,226
Interest on participant loans2013-06-30$0
Interest earned on other investments2013-06-30$17,999
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-06-30$733,314
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-06-30$398,117
Net investment gain/loss from pooled separate accounts2013-06-30$316,456
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-06-30No
Was there a failure to transmit to the plan any participant contributions2013-06-30No
Has the plan failed to provide any benefit when due under the plan2013-06-30No
Contributions received in cash from employer2013-06-30$86,140
Employer contributions (assets) at end of year2013-06-30$0
Employer contributions (assets) at beginning of year2013-06-30$11,457
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-06-30$252,834
Did the plan have assets held for investment2013-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-06-30Yes
Opinion of an independent qualified public accountant for this plan2013-06-30Disclaimer
Accountancy firm name2013-06-30STILES, CARTER AND ASSOCIATES PSC
Accountancy firm EIN2013-06-30611294705
2012 : CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$0
Total income from all sources (including contributions)2012-06-30$232,209
Total loss/gain on sale of assets2012-06-30$0
Total of all expenses incurred2012-06-30$144,397
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-06-30$144,397
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-06-30$264,616
Value of total assets at end of year2012-06-30$2,131,800
Value of total assets at beginning of year2012-06-30$2,043,988
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-06-30$0
Total interest from all sources2012-06-30$11,831
Total dividends received (eg from common stock, registered investment company shares)2012-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-06-30No
Was this plan covered by a fidelity bond2012-06-30Yes
Value of fidelity bond cover2012-06-30$300,000
If this is an individual account plan, was there a blackout period2012-06-30No
Funding deficiency by the employer to the plan for this plan year2012-06-30$0
Minimum employer required contribution for this plan year2012-06-30$0
Amount contributed by the employer to the plan for this plan year2012-06-30$0
Were there any nonexempt tranactions with any party-in-interest2012-06-30No
Contributions received from participants2012-06-30$182,489
Participant contributions at beginning of year2012-06-30$13,712
Other income not declared elsewhere2012-06-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Value of net income/loss2012-06-30$87,812
Value of net assets at end of year (total assets less liabilities)2012-06-30$2,131,800
Value of net assets at beginning of year (total assets less liabilities)2012-06-30$2,043,988
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-06-30No
Were any leases to which the plan was party in default or uncollectible2012-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-06-30$1,722,226
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-06-30$1,688,365
Value of interest in common/collective trusts at beginning of year2012-06-30$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-06-30$11,831
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-06-30$398,117
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-06-30$320,181
Net investment gain/loss from pooled separate accounts2012-06-30$-44,238
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-06-30No
Was there a failure to transmit to the plan any participant contributions2012-06-30Yes
Has the plan failed to provide any benefit when due under the plan2012-06-30No
Contributions received in cash from employer2012-06-30$82,127
Employer contributions (assets) at end of year2012-06-30$11,457
Employer contributions (assets) at beginning of year2012-06-30$21,730
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-06-30$144,397
Did the plan have assets held for investment2012-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-06-30Yes
Opinion of an independent qualified public accountant for this plan2012-06-30Disclaimer
Accountancy firm name2012-06-30DEMING, MALONE, LIVESAY & OSTROFF
Accountancy firm EIN2012-06-30611064249
2011 : CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$0
Total income from all sources (including contributions)2011-06-30$588,671
Total loss/gain on sale of assets2011-06-30$0
Total of all expenses incurred2011-06-30$221,951
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-06-30$221,880
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-06-30$228,667
Value of total assets at end of year2011-06-30$2,043,988
Value of total assets at beginning of year2011-06-30$1,677,268
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-06-30$71
Total interest from all sources2011-06-30$8,688
Total dividends received (eg from common stock, registered investment company shares)2011-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-06-30No
Administrative expenses professional fees incurred2011-06-30$71
Was this plan covered by a fidelity bond2011-06-30Yes
Value of fidelity bond cover2011-06-30$200,000
If this is an individual account plan, was there a blackout period2011-06-30No
Funding deficiency by the employer to the plan for this plan year2011-06-30$0
Minimum employer required contribution for this plan year2011-06-30$0
Amount contributed by the employer to the plan for this plan year2011-06-30$0
Were there any nonexempt tranactions with any party-in-interest2011-06-30No
Contributions received from participants2011-06-30$154,512
Participant contributions at end of year2011-06-30$13,712
Participant contributions at beginning of year2011-06-30$10,421
Administrative expenses (other) incurred2011-06-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Value of net income/loss2011-06-30$366,720
Value of net assets at end of year (total assets less liabilities)2011-06-30$2,043,988
Value of net assets at beginning of year (total assets less liabilities)2011-06-30$1,677,268
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-06-30No
Were any leases to which the plan was party in default or uncollectible2011-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-06-30$1,688,365
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-06-30$1,329,153
Interest on participant loans2011-06-30$0
Interest earned on other investments2011-06-30$0
Value of interest in common/collective trusts at end of year2011-06-30$0
Value of interest in common/collective trusts at beginning of year2011-06-30$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-06-30$8,688
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-06-30$320,181
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-06-30$320,473
Net investment gain/loss from pooled separate accounts2011-06-30$351,316
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-06-30No
Was there a failure to transmit to the plan any participant contributions2011-06-30Yes
Has the plan failed to provide any benefit when due under the plan2011-06-30No
Contributions received in cash from employer2011-06-30$74,155
Employer contributions (assets) at end of year2011-06-30$21,730
Employer contributions (assets) at beginning of year2011-06-30$17,221
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-06-30$221,880
Did the plan have assets held for investment2011-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-06-30Yes
Opinion of an independent qualified public accountant for this plan2011-06-30Disclaimer
Accountancy firm name2011-06-30DEMING, MALONE, LIVESAY & OSTROFF
Accountancy firm EIN2011-06-30611064249
2010 : CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-06-30$0

Form 5500 Responses for CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN

2015: CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingYes
2015-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2009: CAVERNA MEMORIAL HOSPITAL INC. TAX-DEFERRED ANNUITY PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedYes
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVC6507
Policy instance 1
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-750038
Policy instance 2
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-750038
Policy instance 1
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVC6507
Policy instance 2
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberGA-750038
Policy instance 1
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVC6507
Policy instance 2
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVC6507
Policy instance 1
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-750038
Policy instance 2
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVC6507
Policy instance 1
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-750038
Policy instance 2
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-750038
Policy instance 1
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVC6507
Policy instance 2

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