| Plan Name | PACIFICSOURCE 401(K) PLAN |
| Plan identification number | 002 |
| 401k Plan Type | Defined Contribution Pension |
| Plan Features/Benefits |
|
| Company Name: | PACIFICSOURCE HEALTH PLANS |
| Employer identification number (EIN): | 930245545 |
| NAIC Classification: | 524140 |
Additional information about PACIFICSOURCE HEALTH PLANS
| Jurisdiction of Incorporation: | Oregon Secretary of State Corporations Division |
| Incorporation Date: | 2033-04-12 |
| Company Identification Number: | 3651213 |
| Legal Registered Office Address: |
110 INTERNATIONAL WAY SPRINGFIELD United States of America (USA) 97477 |
More information about PACIFICSOURCE HEALTH PLANS
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 002 | 2012-01-01 | PETER DAVIDSON | |||
| 002 | 2011-01-01 | PETER DAVIDSON | |||
| 002 | 2009-01-01 | JANET HARRIS |
| Measure | Date | Value |
|---|---|---|
| 2012 : PACIFICSOURCE 401(K) PLAN 2012 401k financial data | ||
| Total transfer of assets from this plan | 2012-12-31 | $4,255,317 |
| Total income from all sources (including contributions) | 2012-12-31 | $6,781,934 |
| Total of all expenses incurred | 2012-12-31 | $2,728,605 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $2,676,231 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $3,656,894 |
| Value of total assets at end of year | 2012-12-31 | $28,041,222 |
| Value of total assets at beginning of year | 2012-12-31 | $28,243,210 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $52,374 |
| Total interest from all sources | 2012-12-31 | $28,589 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-12-31 | $590,861 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2012-12-31 | $590,861 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $1,300,000 |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2012-12-31 | $0 |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $2,472,656 |
| Participant contributions at end of year | 2012-12-31 | $830,287 |
| Participant contributions at beginning of year | 2012-12-31 | $845,772 |
| Participant contributions at beginning of year | 2012-12-31 | $117 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2012-12-31 | $370,433 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $1,118 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $724 |
| Administrative expenses (other) incurred | 2012-12-31 | $52,374 |
| Total non interest bearing cash at end of year | 2012-12-31 | $5,938 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $4,053,329 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $28,041,222 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $28,243,210 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2012-12-31 | $22,763,263 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2012-12-31 | $20,848,244 |
| Interest on participant loans | 2012-12-31 | $28,589 |
| Value of interest in common/collective trusts at end of year | 2012-12-31 | $4,404,712 |
| Value of interest in common/collective trusts at beginning of year | 2012-12-31 | $6,494,544 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-12-31 | $704 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $21,672 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $21,672 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2012-12-31 | $2,428,166 |
| Net investment gain or loss from common/collective trusts | 2012-12-31 | $77,424 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $813,805 |
| Employer contributions (assets) at end of year | 2012-12-31 | $35,200 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $32,137 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $2,676,231 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-12-31 | No |
| Did the plan have assets held for investment | 2012-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Disclaimer |
| Accountancy firm name | 2012-12-31 | KERNUTT STOKES, LLP |
| Accountancy firm EIN | 2012-12-31 | 930396435 |
| 2011 : PACIFICSOURCE 401(K) PLAN 2011 401k financial data | ||
| Total transfer of assets to this plan | 2011-12-31 | $46,185 |
| Total income from all sources (including contributions) | 2011-12-31 | $3,685,062 |
| Total of all expenses incurred | 2011-12-31 | $1,315,648 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $1,214,248 |
| Expenses. Certain deemed distributions of participant loans | 2011-12-31 | $45,393 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $3,671,423 |
| Value of total assets at end of year | 2011-12-31 | $28,243,210 |
| Value of total assets at beginning of year | 2011-12-31 | $25,827,611 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $56,007 |
| Total interest from all sources | 2011-12-31 | $29,311 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-12-31 | $290,409 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2011-12-31 | $290,409 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $1,300,000 |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | Yes |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2011-12-31 | $0 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $2,254,079 |
| Participant contributions at end of year | 2011-12-31 | $845,772 |
| Participant contributions at beginning of year | 2011-12-31 | $608,812 |
| Participant contributions at end of year | 2011-12-31 | $117 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2011-12-31 | $633,205 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $724 |
| Administrative expenses (other) incurred | 2011-12-31 | $56,007 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $2,369,414 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $28,243,210 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $25,827,611 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2011-12-31 | $20,848,244 |
| Value of interest in pooled separate accounts at beginning of year | 2011-12-31 | $25,218,799 |
| Interest on participant loans | 2011-12-31 | $29,310 |
| Value of interest in common/collective trusts at end of year | 2011-12-31 | $6,494,544 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $21,672 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $1 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2011-12-31 | $-1,551,489 |
| Net investment gain/loss from pooled separate accounts | 2011-12-31 | $1,180,532 |
| Net investment gain or loss from common/collective trusts | 2011-12-31 | $64,876 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $784,139 |
| Employer contributions (assets) at end of year | 2011-12-31 | $32,137 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $1,214,248 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-12-31 | Yes |
| Did the plan have assets held for investment | 2011-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Disclaimer |
| Accountancy firm name | 2011-12-31 | KERNUTT STOKES, LLP |
| Accountancy firm EIN | 2011-12-31 | 930396435 |
| 2010 : PACIFICSOURCE 401(K) PLAN 2010 401k financial data | ||
| Total unrealized appreciation/depreciation of assets | 2010-12-31 | $0 |
| Total transfer of assets to this plan | 2010-12-31 | $7,337,586 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $0 |
| Total income from all sources (including contributions) | 2010-12-31 | $4,966,599 |
| Total loss/gain on sale of assets | 2010-12-31 | $0 |
| Total of all expenses incurred | 2010-12-31 | $997,585 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $968,749 |
| Expenses. Certain deemed distributions of participant loans | 2010-12-31 | $4,807 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $2,985,988 |
| Value of total assets at end of year | 2010-12-31 | $25,827,611 |
| Value of total assets at beginning of year | 2010-12-31 | $14,521,011 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $24,029 |
| Total interest from all sources | 2010-12-31 | $21,256 |
| Total dividends received (eg from common stock, registered investment company shares) | 2010-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $1,300,000 |
| If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2010-12-31 | $0 |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $1,773,154 |
| Participant contributions at end of year | 2010-12-31 | $608,812 |
| Participant contributions at beginning of year | 2010-12-31 | $484,738 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2010-12-31 | $633,948 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $3,969,014 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $25,827,611 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $14,521,011 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Value of interest in pooled separate accounts at end of year | 2010-12-31 | $25,218,799 |
| Value of interest in pooled separate accounts at beginning of year | 2010-12-31 | $14,036,273 |
| Interest on participant loans | 2010-12-31 | $21,256 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2010-12-31 | $0 |
| Net investment gain/loss from pooled separate accounts | 2010-12-31 | $1,959,355 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $578,886 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $968,749 |
| Contract administrator fees | 2010-12-31 | $24,029 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2010-12-31 | No |
| Did the plan have assets held for investment | 2010-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Disclaimer |
| Accountancy firm name | 2010-12-31 | KERNUTT STOKES, LLP |
| Accountancy firm EIN | 2010-12-31 | 930396435 |
| 2009 : PACIFICSOURCE 401(K) PLAN 2009 401k financial data | ||
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2009-12-31 | $0 |
| 2012: PACIFICSOURCE 401(K) PLAN 2012 form 5500 responses | ||
|---|---|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: PACIFICSOURCE 401(K) PLAN 2011 form 5500 responses | ||
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: PACIFICSOURCE 401(K) PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |