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UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 401k Plan overview

Plan NameUTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN
Plan identification number 001

UTAH NAVAJO HEALTH SYSTEM, INC. 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.
  • 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

UTAH NAVAJO HEALTH SYSTEM, INC. has sponsored the creation of one or more 401k plans.

Company Name:UTAH NAVAJO HEALTH SYSTEM, INC.
Employer identification number (EIN):870560763
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01HERB CLAH JR
0012016-01-01HERB CLAH JR
0012015-01-01ALVA CLARKE ALVA CLARKE2016-09-08
0012014-01-01ALVA B CLARKE ALVA B CLARKE2015-10-12
0012013-01-01A. BYRON CLARKE A. BYRON CLARKE2014-09-25
0012012-01-01ALVA BYRON CLARKE ALVA BYRON CLARKE2013-12-11
0012011-01-01ALVA BYRON CLARKE ALVA BYRON CLARKE2013-12-11
0012010-01-01ALVA BYRON CLARKE ALVA BYRON CLARKE2013-12-11
0012009-01-01ALVA BYRON CLARKE ALVA BYRON CLARKE2013-12-03

Plan Statistics for UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN

401k plan membership statisitcs for UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN

Measure Date Value
2022: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01588
Total number of active participants reported on line 7a of the Form 55002022-01-01453
Number of retired or separated participants receiving benefits2022-01-0111
Number of other retired or separated participants entitled to future benefits2022-01-01179
Total of all active and inactive participants2022-01-01643
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01643
Number of participants with account balances2022-01-01628
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-0116
2021: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01519
Total number of active participants reported on line 7a of the Form 55002021-01-01416
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-01162
Total of all active and inactive participants2021-01-01578
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01578
Number of participants with account balances2021-01-01574
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01475
Total number of active participants reported on line 7a of the Form 55002020-01-01399
Number of retired or separated participants receiving benefits2020-01-014
Number of other retired or separated participants entitled to future benefits2020-01-01116
Total of all active and inactive participants2020-01-01519
Total participants2020-01-01519
Number of participants with account balances2020-01-01501
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01422
Total number of active participants reported on line 7a of the Form 55002019-01-01367
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-01107
Total of all active and inactive participants2019-01-01474
Total participants2019-01-01474
Number of participants with account balances2019-01-01468
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01384
Total number of active participants reported on line 7a of the Form 55002018-01-01341
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0181
Total of all active and inactive participants2018-01-01422
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01422
Number of participants with account balances2018-01-01391
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01354
Total number of active participants reported on line 7a of the Form 55002017-01-01303
Number of retired or separated participants receiving benefits2017-01-012
Number of other retired or separated participants entitled to future benefits2017-01-0178
Total of all active and inactive participants2017-01-01383
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-011
Total participants2017-01-01384
Number of participants with account balances2017-01-01373
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01325
Total number of active participants reported on line 7a of the Form 55002016-01-01286
Number of retired or separated participants receiving benefits2016-01-012
Number of other retired or separated participants entitled to future benefits2016-01-0166
Total of all active and inactive participants2016-01-01354
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01354
Number of participants with account balances2016-01-01344
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-011
2015: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01289
Total number of active participants reported on line 7a of the Form 55002015-01-01262
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0163
Total of all active and inactive participants2015-01-01325
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01325
Number of participants with account balances2015-01-01326
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-015
2014: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01292
Total number of active participants reported on line 7a of the Form 55002014-01-01240
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0148
Total of all active and inactive participants2014-01-01288
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01288
Number of participants with account balances2014-01-01288
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-013
2013: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01279
Total number of active participants reported on line 7a of the Form 55002013-01-01221
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0166
Total of all active and inactive participants2013-01-01287
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-011
Total participants2013-01-01288
Number of participants with account balances2013-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01204
Total number of active participants reported on line 7a of the Form 55002012-01-01213
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0148
Total of all active and inactive participants2012-01-01261
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01261
Number of participants with account balances2012-01-01220
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01179
Total number of active participants reported on line 7a of the Form 55002011-01-01156
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0148
Total of all active and inactive participants2011-01-01204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01204
Number of participants with account balances2011-01-01204
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01174
Total number of active participants reported on line 7a of the Form 55002010-01-01179
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-01179
Number of participants with account balances2010-01-01179
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0183
Total number of active participants reported on line 7a of the Form 55002009-01-01174
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01174
Number of participants with account balances2009-01-01174
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN

Measure Date Value
2022 : UTAH NAVAJO HEALTH SYSTEM, INC. 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$1,091
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$142
Total income from all sources (including contributions)2022-12-31$-760,420
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$854,938
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$813,492
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$2,538,367
Value of total assets at end of year2022-12-31$19,242,168
Value of total assets at beginning of year2022-12-31$20,856,577
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$41,446
Total interest from all sources2022-12-31$50,694
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Assets. Real estate other than employer real property at end of year2022-12-31$0
Assets. Real estate other than employer real property at beginning of year2022-12-31$0
Administrative expenses professional fees incurred2022-12-31$8,360
Assets. Corporate prefeered stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$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$1,196,040
Participant contributions at end of year2022-12-31$1,328,280
Participant contributions at beginning of year2022-12-31$1,074,914
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Assets. Other investments not covered elsewhere at end of year2022-12-31$883,658
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$354,810
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$113,111
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Assets. Loans (other than to participants) at end of year2022-12-31$0
Assets. Loans (other than to participants) at beginning of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$1,091
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$142
Liabilities. Value of operating payables at end of year2022-12-31$0
Liabilities. Value of operating payables at beginning of year2022-12-31$0
Total non interest bearing cash at end of year2022-12-31$0
Total non interest bearing cash at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-1,615,358
Value of net assets at end of year (total assets less liabilities)2022-12-31$19,241,077
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$20,856,435
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
Assets. partnership/joint venture interests at end of year2022-12-31$0
Assets. partnership/joint venture interests at beginning of year2022-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$16,400,827
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$18,633,437
Value of interest in pooled separate accounts at end of year2022-12-31$615,226
Value of interest in pooled separate accounts at beginning of year2022-12-31$771,869
Interest on participant loans2022-12-31$50,694
Value of interest in master investment trust accounts at end of year2022-12-31$0
Value of interest in master investment trust accounts at beginning of year2022-12-31$0
Value of interest in common/collective trusts at end of year2022-12-31$0
Value of interest in common/collective trusts at beginning of year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2022-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$0
Asset value of US Government securities at end of year2022-12-31$0
Asset value of US Government securities at beginning of year2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-3,201,197
Net investment gain/loss from pooled separate accounts2022-12-31$-148,284
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
Assets. Invements in employer securities at end of year2022-12-31$0
Assets. Invements in employer securities at beginning of year2022-12-31$0
Assets. Value of employer real property at end of year2022-12-31$0
Assets. Value of employer real property at beginning of year2022-12-31$0
Contributions received in cash from employer2022-12-31$1,229,216
Employer contributions (assets) at end of year2022-12-31$14,177
Employer contributions (assets) at beginning of year2022-12-31$21,547
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$813,492
Asset. Corporate debt instrument preferred debt at end of year2022-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$0
Contract administrator fees2022-12-31$33,086
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2022-12-31$0
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
Liabilities. Value of acquisition indebtedness at end of year2022-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2022-12-31$0
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31WIPFLI LLP
Accountancy firm EIN2022-12-31390758449
2021 : UTAH NAVAJO HEALTH SYSTEM, INC. 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$142
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$67,919
Total income from all sources (including contributions)2021-12-31$4,508,640
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$806,868
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$769,976
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$2,285,676
Value of total assets at end of year2021-12-31$20,856,577
Value of total assets at beginning of year2021-12-31$17,222,582
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$36,892
Total interest from all sources2021-12-31$48,547
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Assets. Real estate other than employer real property at end of year2021-12-31$0
Assets. Real estate other than employer real property at beginning of year2021-12-31$0
Administrative expenses professional fees incurred2021-12-31$7,887
Assets. Corporate prefeered stocks other than exployer securities at end of year2021-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2021-12-31$0
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$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$1,066,826
Participant contributions at end of year2021-12-31$1,074,914
Participant contributions at beginning of year2021-12-31$963,788
Participant contributions at end of year2021-12-31$0
Participant contributions at beginning of year2021-12-31$0
Assets. Other investments not covered elsewhere at end of year2021-12-31$354,810
Assets. Other investments not covered elsewhere at beginning of year2021-12-31$215,910
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$118,519
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$0
Assets. Loans (other than to participants) at end of year2021-12-31$0
Assets. Loans (other than to participants) at beginning of year2021-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$142
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$67,919
Liabilities. Value of operating payables at end of year2021-12-31$0
Liabilities. Value of operating payables at beginning of year2021-12-31$0
Total non interest bearing cash at end of year2021-12-31$0
Total non interest bearing cash at beginning of year2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$3,701,772
Value of net assets at end of year (total assets less liabilities)2021-12-31$20,856,435
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$17,154,663
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
Assets. partnership/joint venture interests at end of year2021-12-31$0
Assets. partnership/joint venture interests at beginning of year2021-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$18,633,437
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$15,322,836
Value of interest in pooled separate accounts at end of year2021-12-31$771,869
Value of interest in pooled separate accounts at beginning of year2021-12-31$708,137
Interest on participant loans2021-12-31$48,547
Value of interest in master investment trust accounts at end of year2021-12-31$0
Value of interest in master investment trust accounts at beginning of year2021-12-31$0
Value of interest in common/collective trusts at end of year2021-12-31$0
Value of interest in common/collective trusts at beginning of year2021-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2021-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2021-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$0
Asset value of US Government securities at end of year2021-12-31$0
Asset value of US Government securities at beginning of year2021-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$2,102,798
Net investment gain/loss from pooled separate accounts2021-12-31$71,619
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
Assets. Invements in employer securities at end of year2021-12-31$0
Assets. Invements in employer securities at beginning of year2021-12-31$0
Assets. Value of employer real property at end of year2021-12-31$0
Assets. Value of employer real property at beginning of year2021-12-31$0
Contributions received in cash from employer2021-12-31$1,100,331
Employer contributions (assets) at end of year2021-12-31$21,547
Employer contributions (assets) at beginning of year2021-12-31$11,911
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$769,976
Asset. Corporate debt instrument preferred debt at end of year2021-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2021-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2021-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2021-12-31$0
Contract administrator fees2021-12-31$29,005
Assets. Corporate common stocks other than exployer securities at end of year2021-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2021-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2021-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2021-12-31$0
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
Liabilities. Value of acquisition indebtedness at end of year2021-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2021-12-31$0
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31CARVER, FLOREK & JAMES
Accountancy firm EIN2021-12-31522408237
2020 : UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$67,919
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$841
Total income from all sources (including contributions)2020-12-31$4,277,619
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$1,076,130
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$1,038,275
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$2,043,661
Value of total assets at end of year2020-12-31$17,222,582
Value of total assets at beginning of year2020-12-31$13,954,015
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$37,855
Total interest from all sources2020-12-31$52,238
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Assets. Real estate other than employer real property at end of year2020-12-31$0
Assets. Real estate other than employer real property at beginning of year2020-12-31$0
Administrative expenses professional fees incurred2020-12-31$7,439
Assets. Corporate prefeered stocks other than exployer securities at end of year2020-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2020-12-31$0
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$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
Contributions received from participants2020-12-31$908,890
Participant contributions at end of year2020-12-31$963,788
Participant contributions at beginning of year2020-12-31$898,508
Participant contributions at end of year2020-12-31$0
Participant contributions at beginning of year2020-12-31$1,066
Assets. Other investments not covered elsewhere at end of year2020-12-31$215,910
Assets. Other investments not covered elsewhere at beginning of year2020-12-31$186,267
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$172,699
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
Assets. Loans (other than to participants) at end of year2020-12-31$0
Assets. Loans (other than to participants) at beginning of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$67,919
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$841
Liabilities. Value of operating payables at end of year2020-12-31$0
Liabilities. Value of operating payables at beginning of year2020-12-31$0
Total non interest bearing cash at end of year2020-12-31$0
Total non interest bearing cash 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$3,201,489
Value of net assets at end of year (total assets less liabilities)2020-12-31$17,154,663
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$13,953,174
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
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Assets. partnership/joint venture interests at end of year2020-12-31$0
Assets. partnership/joint venture interests at beginning of year2020-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$15,322,836
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$12,199,241
Value of interest in pooled separate accounts at end of year2020-12-31$708,137
Value of interest in pooled separate accounts at beginning of year2020-12-31$668,933
Interest on participant loans2020-12-31$52,238
Value of interest in master investment trust accounts at end of year2020-12-31$0
Value of interest in master investment trust accounts at beginning of year2020-12-31$0
Value of interest in common/collective trusts at end of year2020-12-31$0
Value of interest in common/collective trusts at beginning of year2020-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2020-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2020-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$0
Asset value of US Government securities at end of year2020-12-31$0
Asset value of US Government securities at beginning of year2020-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$2,135,077
Net investment gain/loss from pooled separate accounts2020-12-31$46,643
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
Assets. Invements in employer securities at end of year2020-12-31$0
Assets. Invements in employer securities at beginning of year2020-12-31$0
Assets. Value of employer real property at end of year2020-12-31$0
Assets. Value of employer real property at beginning of year2020-12-31$0
Contributions received in cash from employer2020-12-31$962,072
Employer contributions (assets) at end of year2020-12-31$11,911
Employer contributions (assets) at beginning of year2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$1,038,275
Asset. Corporate debt instrument preferred debt at end of year2020-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2020-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2020-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2020-12-31$0
Contract administrator fees2020-12-31$30,416
Assets. Corporate common stocks other than exployer securities at end of year2020-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2020-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2020-12-31$0
Assets. Value of buildings and other operty used in plan operation 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
Liabilities. Value of acquisition indebtedness at end of year2020-12-31$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 name2020-12-31CARVER, FLOREK & JAMES
Accountancy firm EIN2020-12-31522408237
2019 : UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$841
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$17,902
Total income from all sources (including contributions)2019-12-31$4,115,588
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$359,891
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$327,610
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,842,369
Value of total assets at end of year2019-12-31$13,954,015
Value of total assets at beginning of year2019-12-31$10,215,379
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$32,281
Total interest from all sources2019-12-31$56,276
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Assets. Real estate other than employer real property at end of year2019-12-31$0
Assets. Real estate other than employer real property at beginning of year2019-12-31$0
Administrative expenses professional fees incurred2019-12-31$7,017
Assets. Corporate prefeered stocks other than exployer securities at end of year2019-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2019-12-31$0
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
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
Contributions received from participants2019-12-31$822,855
Participant contributions at end of year2019-12-31$898,508
Participant contributions at beginning of year2019-12-31$906,415
Participant contributions at end of year2019-12-31$1,066
Participant contributions at beginning of year2019-12-31$0
Assets. Other investments not covered elsewhere at end of year2019-12-31$186,267
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$123,695
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
Assets. Loans (other than to participants) at end of year2019-12-31$0
Assets. Loans (other than to participants) at beginning of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$841
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$17,902
Liabilities. Value of operating payables at end of year2019-12-31$0
Liabilities. Value of operating payables at beginning of year2019-12-31$0
Total non interest bearing cash at end of year2019-12-31$0
Total non interest bearing cash 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$3,755,697
Value of net assets at end of year (total assets less liabilities)2019-12-31$13,953,174
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$10,197,477
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Assets. partnership/joint venture interests at end of year2019-12-31$0
Assets. partnership/joint venture interests at beginning of year2019-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$12,199,241
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$8,715,799
Value of interest in pooled separate accounts at end of year2019-12-31$668,933
Value of interest in pooled separate accounts at beginning of year2019-12-31$574,599
Interest on participant loans2019-12-31$56,276
Value of interest in master investment trust accounts at end of year2019-12-31$0
Value of interest in master investment trust accounts at beginning of year2019-12-31$0
Value of interest in common/collective trusts at end of year2019-12-31$0
Value of interest in common/collective trusts at beginning of year2019-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2019-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2019-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$0
Asset value of US Government securities at end of year2019-12-31$0
Asset value of US Government securities at beginning of year2019-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$2,115,592
Net investment gain/loss from pooled separate accounts2019-12-31$101,351
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
Assets. Invements in employer securities at end of year2019-12-31$0
Assets. Invements in employer securities at beginning of year2019-12-31$0
Assets. Value of employer real property at end of year2019-12-31$0
Assets. Value of employer real property at beginning of year2019-12-31$0
Contributions received in cash from employer2019-12-31$895,819
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$18,566
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$327,610
Asset. Corporate debt instrument preferred debt at end of year2019-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2019-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2019-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2019-12-31$0
Contract administrator fees2019-12-31$25,264
Assets. Corporate common stocks other than exployer securities at end of year2019-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2019-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2019-12-31$0
Assets. Value of buildings and other operty used in plan operation 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
Liabilities. Value of acquisition indebtedness at end of year2019-12-31$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 name2019-12-31CARVER, FLOREK & JAMES
Accountancy firm EIN2019-12-31522408237
2018 : UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$17,902
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$15,411
Total income from all sources (including contributions)2018-12-31$1,011,205
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$590,390
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$545,424
Value of total corrective distributions2018-12-31$17,802
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$1,658,394
Value of total assets at end of year2018-12-31$10,215,379
Value of total assets at beginning of year2018-12-31$9,792,073
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$27,164
Total interest from all sources2018-12-31$44,922
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Assets. Real estate other than employer real property at end of year2018-12-31$0
Assets. Real estate other than employer real property at beginning of year2018-12-31$0
Administrative expenses professional fees incurred2018-12-31$6,620
Assets. Corporate prefeered stocks other than exployer securities at end of year2018-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2018-12-31$0
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$774,407
Participant contributions at end of year2018-12-31$906,415
Participant contributions at beginning of year2018-12-31$835,028
Participant contributions at end of year2018-12-31$0
Participant contributions at beginning of year2018-12-31$-25
Assets. Other investments not covered elsewhere at end of year2018-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2018-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$62,284
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
Assets. Loans (other than to participants) at end of year2018-12-31$0
Assets. Loans (other than to participants) at beginning of year2018-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$17,902
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$15,411
Other income not declared elsewhere2018-12-31$-638,292
Total non interest bearing cash at end of year2018-12-31$0
Total non interest bearing cash 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$420,815
Value of net assets at end of year (total assets less liabilities)2018-12-31$10,197,477
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$9,776,662
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Assets. partnership/joint venture interests at end of year2018-12-31$0
Assets. partnership/joint venture interests at beginning of year2018-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$8,715,799
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$8,322,032
Value of interest in pooled separate accounts at end of year2018-12-31$574,599
Value of interest in pooled separate accounts at beginning of year2018-12-31$635,038
Interest on participant loans2018-12-31$44,922
Value of interest in master investment trust accounts at end of year2018-12-31$0
Value of interest in master investment trust accounts at beginning of year2018-12-31$0
Value of interest in common/collective trusts at end of year2018-12-31$0
Value of interest in common/collective trusts at beginning of year2018-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2018-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2018-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$0
Asset value of US Government securities at end of year2018-12-31$0
Asset value of US Government securities at beginning of year2018-12-31$0
Net investment gain/loss from pooled separate accounts2018-12-31$-53,819
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
Assets. Invements in employer securities at end of year2018-12-31$0
Assets. Invements in employer securities at beginning of year2018-12-31$0
Assets. Value of employer real property at end of year2018-12-31$0
Assets. Value of employer real property at beginning of year2018-12-31$0
Contributions received in cash from employer2018-12-31$821,703
Employer contributions (assets) at end of year2018-12-31$18,566
Employer contributions (assets) at beginning of year2018-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$545,424
Asset. Corporate debt instrument preferred debt at end of year2018-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2018-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2018-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2018-12-31$0
Contract administrator fees2018-12-31$20,544
Assets. Corporate common stocks other than exployer securities at end of year2018-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2018-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2018-12-31$0
Assets. Value of buildings and other operty used in plan operation 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
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 name2018-12-31CARVER, FLOREK & JAMES
Accountancy firm EIN2018-12-31522408237
2017 : UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$15,411
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$10,829
Total income from all sources (including contributions)2017-12-31$2,648,384
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$582,570
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$542,206
Value of total corrective distributions2017-12-31$15,311
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$1,404,862
Value of total assets at end of year2017-12-31$9,792,073
Value of total assets at beginning of year2017-12-31$7,721,677
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$25,053
Total interest from all sources2017-12-31$33,208
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Assets. Real estate other than employer real property at end of year2017-12-31$0
Assets. Real estate other than employer real property at beginning of year2017-12-31$0
Administrative expenses professional fees incurred2017-12-31$6,276
Assets. Corporate prefeered stocks other than exployer securities at end of year2017-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2017-12-31$0
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$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
Contributions received from participants2017-12-31$642,848
Participant contributions at end of year2017-12-31$835,028
Participant contributions at beginning of year2017-12-31$653,533
Participant contributions at end of year2017-12-31$-25
Participant contributions at beginning of year2017-12-31$-25
Assets. Other investments not covered elsewhere at end of year2017-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2017-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$20,578
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
Assets. Loans (other than to participants) at end of year2017-12-31$0
Assets. Loans (other than to participants) at beginning of year2017-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$15,411
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$10,829
Total non interest bearing cash at end of year2017-12-31$0
Total non interest bearing cash 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$2,065,814
Value of net assets at end of year (total assets less liabilities)2017-12-31$9,776,662
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$7,710,848
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
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Assets. partnership/joint venture interests at end of year2017-12-31$0
Assets. partnership/joint venture interests at beginning of year2017-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$8,322,032
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$6,486,435
Value of interest in pooled separate accounts at end of year2017-12-31$635,038
Value of interest in pooled separate accounts at beginning of year2017-12-31$568,060
Interest on participant loans2017-12-31$33,208
Value of interest in master investment trust accounts at end of year2017-12-31$0
Value of interest in master investment trust accounts at beginning of year2017-12-31$0
Value of interest in common/collective trusts at end of year2017-12-31$0
Value of interest in common/collective trusts at beginning of year2017-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2017-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2017-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$0
Asset value of US Government securities at end of year2017-12-31$0
Asset value of US Government securities at beginning of year2017-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$1,137,060
Net investment gain/loss from pooled separate accounts2017-12-31$73,254
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
Assets. Invements in employer securities at end of year2017-12-31$0
Assets. Invements in employer securities at beginning of year2017-12-31$0
Assets. Value of employer real property at end of year2017-12-31$0
Assets. Value of employer real property at beginning of year2017-12-31$0
Contributions received in cash from employer2017-12-31$741,436
Employer contributions (assets) at end of year2017-12-31$0
Employer contributions (assets) at beginning of year2017-12-31$13,674
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$542,206
Asset. Corporate debt instrument preferred debt at end of year2017-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2017-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2017-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2017-12-31$0
Contract administrator fees2017-12-31$18,777
Assets. Corporate common stocks other than exployer securities at end of year2017-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2017-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2017-12-31$0
Assets. Value of buildings and other operty used in plan operation 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
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 name2017-12-31CARVER, FLOREK & JAMES
Accountancy firm EIN2017-12-31522408237
2016 : UTAH NAVAJO HEALTH SYSTEM, INC. 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 transfer of assets from this plan2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$10,829
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$103
Expenses. Interest paid2016-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022016-12-31$0
Total income from all sources (including contributions)2016-12-31$1,780,386
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$638,047
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$604,564
Expenses. Certain deemed distributions of participant loans2016-12-31$0
Value of total corrective distributions2016-12-31$10,729
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$1,330,275
Value of total assets at end of year2016-12-31$7,721,677
Value of total assets at beginning of year2016-12-31$6,568,612
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$22,754
Total income from rents2016-12-31$0
Total interest from all sources2016-12-31$28,195
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
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$0
Assets. Real estate other than employer real property at end of year2016-12-31$0
Assets. Real estate other than employer real property at beginning of year2016-12-31$0
Administrative expenses professional fees incurred2016-12-31$5,892
Assets. Corporate prefeered stocks other than exployer securities at end of year2016-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2016-12-31$0
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$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
Contributions received from participants2016-12-31$617,568
Participant contributions at end of year2016-12-31$653,533
Participant contributions at beginning of year2016-12-31$486,626
Participant contributions at end of year2016-12-31$-25
Participant contributions at beginning of year2016-12-31$0
Assets. Other investments not covered elsewhere at end of year2016-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2016-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$25,090
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
Assets. Loans (other than to participants) at end of year2016-12-31$0
Assets. Loans (other than to participants) at beginning of year2016-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$10,829
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$103
Other income not declared elsewhere2016-12-31$0
Administrative expenses (other) incurred2016-12-31$0
Total non interest bearing cash at end of year2016-12-31$0
Total non interest bearing cash 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
Income. Non cash contributions2016-12-31$0
Value of net income/loss2016-12-31$1,142,339
Value of net assets at end of year (total assets less liabilities)2016-12-31$7,710,848
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$6,568,509
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
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Assets. partnership/joint venture interests at end of year2016-12-31$0
Assets. partnership/joint venture interests at beginning of 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$6,486,435
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$5,517,574
Value of interest in pooled separate accounts at end of year2016-12-31$568,060
Value of interest in pooled separate accounts at beginning of year2016-12-31$560,735
Interest on participant loans2016-12-31$28,195
Income. Interest from loans (other than to participants)2016-12-31$0
Interest earned on other investments2016-12-31$0
Income. Interest from US Government securities2016-12-31$0
Income. Interest from corporate debt instruments2016-12-31$0
Value of interest in master investment trust accounts at end of year2016-12-31$0
Value of interest in master investment trust accounts at beginning of year2016-12-31$0
Value of interest in common/collective trusts at end of year2016-12-31$0
Value of interest in common/collective trusts at beginning of year2016-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2016-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2016-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$0
Asset value of US Government securities at end of year2016-12-31$0
Asset value of US Government securities at beginning of year2016-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$408,698
Net investment gain/loss from pooled separate accounts2016-12-31$13,218
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
Assets. Invements in employer securities at end of year2016-12-31$0
Assets. Invements in employer securities at beginning of year2016-12-31$0
Assets. Value of employer real property at end of year2016-12-31$0
Assets. Value of employer real property at beginning of year2016-12-31$0
Contributions received in cash from employer2016-12-31$687,617
Employer contributions (assets) at end of year2016-12-31$13,674
Employer contributions (assets) at beginning of year2016-12-31$3,677
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$604,564
Asset. Corporate debt instrument preferred debt at end of year2016-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2016-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2016-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2016-12-31$0
Contract administrator fees2016-12-31$16,862
Assets. Corporate common stocks other than exployer securities at end of year2016-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2016-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2016-12-31$0
Assets. Value of buildings and other operty used in plan operation 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
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 name2016-12-31CARVER, FLOREK & JAMES
Accountancy firm EIN2016-12-31522408237
2015 : UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$103
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$9,132
Total income from all sources (including contributions)2015-12-31$1,138,924
Total of all expenses incurred2015-12-31$626,946
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$614,251
Value of total corrective distributions2015-12-31$3
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,325,020
Value of total assets at end of year2015-12-31$6,568,612
Value of total assets at beginning of year2015-12-31$6,065,663
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$12,692
Total interest from all sources2015-12-31$19,029
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$5,557
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$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
Contributions received from participants2015-12-31$592,074
Participant contributions at end of year2015-12-31$486,626
Participant contributions at beginning of year2015-12-31$364,591
Participant contributions at end of year2015-12-31$0
Participant contributions at beginning of year2015-12-31$21,519
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$91,895
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$103
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$9,132
Total non interest bearing cash 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$511,978
Value of net assets at end of year (total assets less liabilities)2015-12-31$6,568,509
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$6,056,531
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$5,517,574
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$5,051,730
Value of interest in pooled separate accounts at end of year2015-12-31$560,735
Value of interest in pooled separate accounts at beginning of year2015-12-31$621,956
Income. Interest from loans (other than to participants)2015-12-31$19,029
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-192,148
Net investment gain/loss from pooled separate accounts2015-12-31$-12,977
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$641,051
Employer contributions (assets) at end of year2015-12-31$3,677
Employer contributions (assets) at beginning of year2015-12-31$5,867
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$614,251
Contract administrator fees2015-12-31$7,135
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
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 name2015-12-31CARVER, FLOREK & JAMES
Accountancy firm EIN2015-12-31522408237
2014 : UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$9,132
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$100
Total income from all sources (including contributions)2014-12-31$1,597,018
Total of all expenses incurred2014-12-31$721,815
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$704,120
Value of total corrective distributions2014-12-31$3,311
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$1,321,984
Value of total assets at end of year2014-12-31$6,065,663
Value of total assets at beginning of year2014-12-31$5,181,428
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$14,384
Total interest from all sources2014-12-31$9,536
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Administrative expenses professional fees incurred2014-12-31$5,994
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
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
Contributions received from participants2014-12-31$588,699
Participant contributions at end of year2014-12-31$364,591
Participant contributions at beginning of year2014-12-31$137,497
Participant contributions at end of year2014-12-31$21,519
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$120,520
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$9,132
Total non interest bearing cash at end of year2014-12-31$0
Total non interest bearing cash at beginning of year2014-12-31$20,440
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$875,203
Value of net assets at end of year (total assets less liabilities)2014-12-31$6,056,531
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$5,181,328
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
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$5,051,730
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$4,108,903
Value of interest in pooled separate accounts at end of year2014-12-31$621,956
Value of interest in pooled separate accounts at beginning of year2014-12-31$875,108
Interest on participant loans2014-12-31$9,536
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$243,140
Net investment gain/loss from pooled separate accounts2014-12-31$22,358
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$612,765
Employer contributions (assets) at end of year2014-12-31$5,867
Employer contributions (assets) at beginning of year2014-12-31$39,480
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$704,120
Contract administrator fees2014-12-31$8,390
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
Liabilities. Value of acquisition indebtedness at beginning of year2014-12-31$100
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 name2014-12-31CARVER, FLOREK & JAMES
Accountancy firm EIN2014-12-31522408237
2013 : UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$100
Total income from all sources (including contributions)2013-12-31$1,684,535
Total of all expenses incurred2013-12-31$426,728
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$422,903
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$1,038,234
Value of total assets at end of year2013-12-31$5,181,428
Value of total assets at beginning of year2013-12-31$3,923,521
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$3,825
Total interest from all sources2013-12-31$2,255
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$3,825
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
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
Contributions received from participants2013-12-31$434,684
Participant contributions at end of year2013-12-31$137,497
Participant contributions at beginning of year2013-12-31$47,793
Participant contributions at beginning of year2013-12-31$6,917
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$25,052
Other income not declared elsewhere2013-12-31$0
Total non interest bearing cash at end of year2013-12-31$20,440
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$1,257,807
Value of net assets at end of year (total assets less liabilities)2013-12-31$5,181,328
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$3,923,521
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
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$4,108,903
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$2,487,985
Value of interest in pooled separate accounts at end of year2013-12-31$875,108
Value of interest in pooled separate accounts at beginning of year2013-12-31$1,367,845
Interest on participant loans2013-12-31$2,255
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$539,134
Net investment gain/loss from pooled separate accounts2013-12-31$104,912
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$578,498
Employer contributions (assets) at end of year2013-12-31$39,480
Employer contributions (assets) at beginning of year2013-12-31$12,981
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$422,903
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
Liabilities. Value of acquisition indebtedness at end of year2013-12-31$100
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 name2013-12-31CARVER, FLOREK & JAMES
Accountancy firm EIN2013-12-31522408237
2012 : UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2012 401k financial data
Total income from all sources (including contributions)2012-12-31$912,086
Total of all expenses incurred2012-12-31$798,617
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$798,617
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$652,503
Value of total assets at end of year2012-12-31$3,923,521
Value of total assets at beginning of year2012-12-31$3,810,052
Total interest from all sources2012-12-31$82
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$100,000
If this is an individual account plan, was there a blackout period2012-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$214,198
Participant contributions at end of year2012-12-31$47,793
Participant contributions at end of year2012-12-31$6,917
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$64,973
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$113,469
Value of net assets at end of year (total assets less liabilities)2012-12-31$3,923,521
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$3,810,052
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
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$2,487,985
Value of interest in pooled separate accounts at end of year2012-12-31$1,367,845
Value of interest in pooled separate accounts at beginning of year2012-12-31$3,810,052
Interest on participant loans2012-12-31$82
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$-3,707
Net investment gain/loss from pooled separate accounts2012-12-31$263,208
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 contributions2012-12-31Yes
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$373,332
Employer contributions (assets) at end of year2012-12-31$12,981
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$798,617
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31Yes
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
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 name2012-12-31CARVER, FLOREK & JAMES
Accountancy firm EIN2012-12-31522408237
2011 : UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2011 401k financial data
Total income from all sources (including contributions)2011-12-31$755,995
Total of all expenses incurred2011-12-31$265,761
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$265,761
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$788,329
Value of total assets at end of year2011-12-31$3,810,052
Value of total assets at beginning of year2011-12-31$3,319,818
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$100,000
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
Contributions received from participants2011-12-31$196,517
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$239,676
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$490,234
Value of net assets at end of year (total assets less liabilities)2011-12-31$3,810,052
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$3,319,818
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$0
Value of interest in pooled separate accounts at end of year2011-12-31$3,810,052
Value of interest in pooled separate accounts at beginning of year2011-12-31$3,319,818
Value of interest in master investment trust accounts at end of year2011-12-31$0
Value of interest in master investment trust accounts at beginning of year2011-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2011-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2011-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$0
Net investment gain/loss from pooled separate accounts2011-12-31$-32,334
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$352,136
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$265,761
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31CARVER, FLOREK & JAMES
Accountancy firm EIN2011-12-31522408237
2010 : UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2010 401k financial data
Total income from all sources (including contributions)2010-12-31$813,731
Total of all expenses incurred2010-12-31$206,482
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$206,482
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$503,092
Value of total assets at end of year2010-12-31$3,319,818
Value of total assets at beginning of year2010-12-31$2,712,569
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$100,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$184,864
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$6,616
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$607,249
Value of net assets at end of year (total assets less liabilities)2010-12-31$3,319,818
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$2,712,569
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in pooled separate accounts at end of year2010-12-31$3,319,818
Value of interest in pooled separate accounts at beginning of year2010-12-31$2,712,569
Net investment gain/loss from pooled separate accounts2010-12-31$310,639
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$311,612
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$206,482
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31CARVER, FLORECK & JAMES
Accountancy firm EIN2010-12-31522408237
2009 : UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN

2022: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final 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: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
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: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
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: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
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: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
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: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
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: UTAH NAVAJO HEALTH SYSTEM, INC. 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: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
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: UTAH NAVAJO HEALTH SYSTEM, INC. 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 benefit arrangement – InsuranceYes
2010: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedYes
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: UTAH NAVAJO HEALTH SYSTEM, INC. 403(B) PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number786-80072
Policy instance 1
Insurance contract or identification number786-80072
Number of Individuals Covered27
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number786-80072
Policy instance 1
Insurance contract or identification number786-80072
Number of Individuals Covered24
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number786-80072
Policy instance 1
Insurance contract or identification number786-80072
Number of Individuals Covered21
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number786-80072
Policy instance 1
Insurance contract or identification number786-80072
Number of Individuals Covered25
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )
Policy contract numberW0116 W0119
Policy instance 2
Insurance contract or identification numberW0116 W0119
Number of Individuals Covered1
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUCO LIFE INSURANCE CO. OF NJ (National Association of Insurance Commissioners NAIC id number: 97195 )
Policy contract numberE1030555
Policy instance 1
Insurance contract or identification numberE1030555
Number of Individuals Covered1
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )
Policy contract numberW0116 W0119
Policy instance 2
Insurance contract or identification numberW0116 W0119
Number of Individuals Covered2
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUCO LIFE INSURANCE CO. OF NJ (National Association of Insurance Commissioners NAIC id number: 97195 )
Policy contract numberE1030555
Policy instance 1
Insurance contract or identification numberE1030555
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUCO LIFE INSURANCE CO. OF NJ (National Association of Insurance Commissioners NAIC id number: 97195 )
Policy contract numberE1030555
Policy instance 1
Insurance contract or identification numberE1030555
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )
Policy contract numberW0116 W0119
Policy instance 2
Insurance contract or identification numberW0116 W0119
Number of Individuals Covered2
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )
Policy contract numberW0116 W0119
Policy instance 2
Insurance contract or identification numberW0116 W0119
Number of Individuals Covered3
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
PRUCO LIFE INSURANCE CO. OF NJ (National Association of Insurance Commissioners NAIC id number: 97195 )
Policy contract numberE1030555
Policy instance 1
Insurance contract or identification numberE1030555
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )
Policy contract numberW0116 W0119
Policy instance 4
Insurance contract or identification numberW0116 W0119
Number of Individuals Covered6
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberJH16000281110
Policy instance 3
Insurance contract or identification numberJH16000281110
Number of Individuals Covered4
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
PRUCO LIFE INSURANCE CO. OF NJ (National Association of Insurance Commissioners NAIC id number: 97195 )
Policy contract numberE1030555
Policy instance 2
Insurance contract or identification numberE1030555
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
GREAT AMERICAN LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 93661 )
Policy contract numberA001322
Policy instance 1
Insurance contract or identification numberA001322
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
PRUCO LIFE INSURANCE CO. OF NJ (National Association of Insurance Commissioners NAIC id number: 97195 )
Policy contract numberE1030555
Policy instance 2
Insurance contract or identification numberE1030555
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,547
Total amount of fees paid to insurance companyUSD $0
Commission paid to Insurance BrokerUSD $1,547
Insurance broker organization code?3
Insurance broker nameJOSEPH HILL
GREAT AMERICAN LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 93661 )
Policy contract numberA001322
Policy instance 1
Insurance contract or identification numberA001322
Number of Individuals Covered2
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,696
Total amount of fees paid to insurance companyUSD $0
Commission paid to Insurance BrokerUSD $1,696
Insurance broker organization code?3
Insurance broker nameJOSEPH HILL
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberJH16000281110
Policy instance 3
Insurance contract or identification numberJH16000281110
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $692
Commission paid to Insurance BrokerUSD $692
Insurance broker organization code?3
Insurance broker nameJOSEPH HILL
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )
Policy contract numberW0116 W0119
Policy instance 4
Insurance contract or identification numberW0116 W0119
Number of Individuals Covered34
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,225
Commission paid to Insurance BrokerUSD $1,225
Insurance broker organization code?3
Insurance broker nameJOSEPH HILL
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberJH16000281110
Policy instance 1
Insurance contract or identification numberJH16000281110
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,651
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )
Policy contract numberW0116 W0119
Policy instance 2
Insurance contract or identification numberW0116 W0119
Number of Individuals Covered22
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,595
GREAT AMERICAN LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 93661 )
Policy contract numberA001322
Policy instance 3
Insurance contract or identification numberA001322
Number of Individuals Covered175
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,171
Total amount of fees paid to insurance companyUSD $0
PRUCO LIFE INSURANCE CO. OF NJ (National Association of Insurance Commissioners NAIC id number: 97195 )
Policy contract numberE1030555
Policy instance 4
Insurance contract or identification numberE1030555
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,513
PRUCO LIFE INSURANCE CO. OF NJ (National Association of Insurance Commissioners NAIC id number: 97195 )
Policy contract numberE1030555
Policy instance 1
Insurance contract or identification numberE1030555
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $17,204
Total amount of fees paid to insurance companyUSD $0
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberJH16000281110
Policy instance 2
Insurance contract or identification numberJH16000281110
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $483
GREAT AMERICAN LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 93661 )
Policy contract numberA001322
Policy instance 4
Insurance contract or identification numberA001322
Number of Individuals Covered150
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,007
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )
Policy contract numberW0116 & W0119
Policy instance 3
Insurance contract or identification numberW0116 & W0119
Number of Individuals Covered27
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,632

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