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SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 401k Plan overview

Plan NameSUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN
Plan identification number 001

SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

SUTTER EAST BAY HOSPITALS has sponsored the creation of one or more 401k plans.

Company Name:SUTTER EAST BAY HOSPITALS
Employer identification number (EIN):941196176
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about SUTTER EAST BAY HOSPITALS

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: C0169633

More information about SUTTER EAST BAY HOSPITALS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012016-01-01VICTORIA FLEMMING
0012015-01-01VICTORIA FLEMMING
0012014-01-01VICTORIA FLEMMING
0012013-01-01VICTORIA FLEMMING
0012012-01-01VICTORIA FLEMMING
0012011-01-01MARK BEITING
0012009-01-01MARK BEITING

Plan Statistics for SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN

401k plan membership statisitcs for SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN

Measure Date Value
2016: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01568
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-010
Number of participants with account balances2016-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01625
Total number of active participants reported on line 7a of the Form 55002015-01-01249
Number of retired or separated participants receiving benefits2015-01-0133
Number of other retired or separated participants entitled to future benefits2015-01-01283
Total of all active and inactive participants2015-01-01565
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-013
Total participants2015-01-01568
Number of participants with account balances2015-01-01568
2014: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01677
Total number of active participants reported on line 7a of the Form 55002014-01-01276
Number of retired or separated participants receiving benefits2014-01-0117
Number of other retired or separated participants entitled to future benefits2014-01-01330
Total of all active and inactive participants2014-01-01623
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-012
Total participants2014-01-01625
Number of participants with account balances2014-01-01625
2013: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01726
Total number of active participants reported on line 7a of the Form 55002013-01-01267
Number of retired or separated participants receiving benefits2013-01-0117
Number of other retired or separated participants entitled to future benefits2013-01-01392
Total of all active and inactive participants2013-01-01676
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-011
Total participants2013-01-01677
Number of participants with account balances2013-01-01677
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01782
Total number of active participants reported on line 7a of the Form 55002012-01-01361
Number of retired or separated participants receiving benefits2012-01-0115
Number of other retired or separated participants entitled to future benefits2012-01-01349
Total of all active and inactive participants2012-01-01725
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-011
Total participants2012-01-01726
Number of participants with account balances2012-01-01726
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01831
Total number of active participants reported on line 7a of the Form 55002011-01-01351
Number of retired or separated participants receiving benefits2011-01-0116
Number of other retired or separated participants entitled to future benefits2011-01-01414
Total of all active and inactive participants2011-01-01781
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-011
Total participants2011-01-01782
Number of participants with account balances2011-01-01782
2009: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01900
Total number of active participants reported on line 7a of the Form 55002009-01-01407
Number of retired or separated participants receiving benefits2009-01-0112
Number of other retired or separated participants entitled to future benefits2009-01-01454
Total of all active and inactive participants2009-01-01873
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-012
Total participants2009-01-01875
Number of participants with account balances2009-01-01875

Financial Data on SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN

Measure Date Value
2016 : SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2016 401k financial data
Total transfer of assets from this plan2016-09-02$13,171,741
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-02$2,317
Total income from all sources (including contributions)2016-09-02$584,929
Total of all expenses incurred2016-09-02$869,725
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-09-02$859,969
Value of total assets at end of year2016-09-02$0
Value of total assets at beginning of year2016-09-02$13,458,854
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-09-02$9,756
Total interest from all sources2016-09-02$47,094
Total dividends received (eg from common stock, registered investment company shares)2016-09-02$103,280
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-09-02Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2016-09-02$0
Total dividends received from registered investment company shares (eg mutual funds)2016-09-02$103,280
Was this plan covered by a fidelity bond2016-09-02Yes
Value of fidelity bond cover2016-09-02$10,000,000
If this is an individual account plan, was there a blackout period2016-09-02Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-09-02$0
Were there any nonexempt tranactions with any party-in-interest2016-09-02No
Participant contributions at end of year2016-09-02$0
Participant contributions at beginning of year2016-09-02$13,248
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-09-02$7,426
Other income not declared elsewhere2016-09-02$6,876
Administrative expenses (other) incurred2016-09-02$9,756
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-02No
Value of net income/loss2016-09-02$-284,796
Value of net assets at end of year (total assets less liabilities)2016-09-02$0
Value of net assets at beginning of year (total assets less liabilities)2016-09-02$13,456,537
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-09-02No
Were any loans by the plan or fixed income obligations due to the plan in default2016-09-02No
Were any leases to which the plan was party in default or uncollectible2016-09-02No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-09-02$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-09-02$10,307,907
Value of interest in pooled separate accounts at end of year2016-09-02$0
Value of interest in pooled separate accounts at beginning of year2016-09-02$1,079,280
Interest on participant loans2016-09-02$204
Interest earned on other investments2016-09-02$46,890
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-09-02$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-09-02$2,050,993
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-09-02$427,679
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-09-02No
Was there a failure to transmit to the plan any participant contributions2016-09-02No
Has the plan failed to provide any benefit when due under the plan2016-09-02No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-09-02$859,969
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-09-02Yes
Liabilities. Value of benefit claims payable at beginning of year2016-09-02$2,317
Did the plan have assets held for investment2016-09-02No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-02No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-09-02Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-09-02No
Opinion of an independent qualified public accountant for this plan2016-09-02Disclaimer
Accountancy firm name2016-09-02MOSS ADAMS LLP
Accountancy firm EIN2016-09-02910189318
2015 : SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2015 401k financial data
Total transfer of assets from this plan2015-12-31$124,890
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$2,317
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$88,614
Total income from all sources (including contributions)2015-12-31$145,477
Total of all expenses incurred2015-12-31$2,421,854
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$2,401,567
Expenses. Certain deemed distributions of participant loans2015-12-31$19,704
Value of total assets at end of year2015-12-31$13,458,854
Value of total assets at beginning of year2015-12-31$15,946,418
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$583
Total interest from all sources2015-12-31$76,212
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$613,923
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$613,923
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$10,000,000
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
Participant contributions at end of year2015-12-31$13,248
Participant contributions at beginning of year2015-12-31$29,791
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$7,426
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$2,260
Other income not declared elsewhere2015-12-31$13,271
Administrative expenses (other) incurred2015-12-31$583
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-2,276,377
Value of net assets at end of year (total assets less liabilities)2015-12-31$13,456,537
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$15,857,804
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$10,307,907
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$13,562,518
Value of interest in pooled separate accounts at end of year2015-12-31$1,079,280
Value of interest in pooled separate accounts at beginning of year2015-12-31$86,344
Interest on participant loans2015-12-31$727
Interest earned on other investments2015-12-31$75,485
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$2,050,993
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$2,265,505
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-557,929
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$2,401,567
Liabilities. Value of benefit claims payable at end of year2015-12-31$2,317
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$88,614
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)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31MOSS ADAMS LLP
Accountancy firm EIN2015-12-31910189318
2014 : SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2014 401k financial data
Total transfer of assets from this plan2014-12-31$5,530
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$88,614
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$6,485
Total income from all sources (including contributions)2014-12-31$1,176,895
Total of all expenses incurred2014-12-31$1,840,703
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$1,838,641
Value of total assets at end of year2014-12-31$15,946,418
Value of total assets at beginning of year2014-12-31$16,533,627
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$2,062
Total interest from all sources2014-12-31$80,526
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$699,122
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$699,122
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$10,000,000
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
Participant contributions at end of year2014-12-31$29,791
Participant contributions at beginning of year2014-12-31$40,273
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$2,260
Other income not declared elsewhere2014-12-31$11,568
Administrative expenses (other) incurred2014-12-31$2,062
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-663,808
Value of net assets at end of year (total assets less liabilities)2014-12-31$15,857,804
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$16,527,142
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$13,562,518
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$13,977,794
Value of interest in pooled separate accounts at end of year2014-12-31$86,344
Value of interest in pooled separate accounts at beginning of year2014-12-31$86,573
Interest on participant loans2014-12-31$1,346
Interest earned on other investments2014-12-31$79,180
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$2,265,505
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$2,428,987
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$385,679
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$1,838,641
Liabilities. Value of benefit claims payable at end of year2014-12-31$88,614
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$6,485
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
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31MOSS ADAMS LLP
Accountancy firm EIN2014-12-31910189318
2013 : SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total transfer of assets from this plan2013-12-31$22,075
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$6,485
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$48,824
Total income from all sources (including contributions)2013-12-31$2,738,243
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$1,281,101
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$1,279,095
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$0
Value of total assets at end of year2013-12-31$16,533,627
Value of total assets at beginning of year2013-12-31$15,140,899
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$2,006
Total interest from all sources2013-12-31$85,530
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$545,049
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$545,049
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$10,000,000
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
Participant contributions at end of year2013-12-31$40,273
Participant contributions at beginning of year2013-12-31$64,957
Administrative expenses (other) incurred2013-12-31$2,006
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$1,457,142
Value of net assets at end of year (total assets less liabilities)2013-12-31$16,527,142
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$15,092,075
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$13,977,794
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$12,433,788
Value of interest in pooled separate accounts at end of year2013-12-31$86,573
Value of interest in pooled separate accounts at beginning of year2013-12-31$112,765
Interest on participant loans2013-12-31$2,518
Interest earned on other investments2013-12-31$83,012
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$2,428,987
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$2,529,389
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$2,107,664
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$1,279,095
Liabilities. Value of benefit claims payable at end of year2013-12-31$6,485
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$48,824
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
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31ERNST & YOUNG LLP
Accountancy firm EIN2013-12-31346565596
2012 : SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total transfer of assets from this plan2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$48,824
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total income from all sources (including contributions)2012-12-31$1,614,483
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$1,724,811
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$1,723,880
Expenses. Certain deemed distributions of participant loans2012-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$0
Value of total assets at end of year2012-12-31$15,140,899
Value of total assets at beginning of year2012-12-31$15,202,403
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$931
Total interest from all sources2012-12-31$94,281
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$263,848
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$263,848
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$10,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Participant contributions at end of year2012-12-31$64,957
Participant contributions at beginning of year2012-12-31$55,945
Administrative expenses (other) incurred2012-12-31$931
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$-110,328
Value of net assets at end of year (total assets less liabilities)2012-12-31$15,092,075
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$15,202,403
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$12,433,788
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$12,376,787
Value of interest in pooled separate accounts at end of year2012-12-31$112,765
Value of interest in pooled separate accounts at beginning of year2012-12-31$121,563
Interest on participant loans2012-12-31$2,935
Interest earned on other investments2012-12-31$91,346
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$2,529,389
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$2,648,108
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$1,256,354
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$1,723,880
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Liabilities. Value of benefit claims payable at end of year2012-12-31$48,824
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$0
Did the plan have assets held for investment2012-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31ERNST & YOUNG LLP
Accountancy firm EIN2012-12-31346565596
2011 : SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2011 401k financial data
Total transfer of assets from this plan2011-12-31$42,225
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$10,478
Total income from all sources (including contributions)2011-12-31$-57,943
Total of all expenses incurred2011-12-31$1,341,391
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$1,337,462
Expenses. Certain deemed distributions of participant loans2011-12-31$2,686
Value of total assets at end of year2011-12-31$15,202,403
Value of total assets at beginning of year2011-12-31$16,654,440
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$1,243
Total interest from all sources2011-12-31$98,861
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$204,921
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$204,921
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$10,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Participant contributions at end of year2011-12-31$55,945
Participant contributions at beginning of year2011-12-31$63,313
Administrative expenses (other) incurred2011-12-31$1,243
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-1,399,334
Value of net assets at end of year (total assets less liabilities)2011-12-31$15,202,403
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$16,643,962
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 end of year2011-12-31$12,376,787
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$12,364,263
Value of interest in pooled separate accounts at end of year2011-12-31$121,563
Interest on participant loans2011-12-31$2,720
Interest earned on other investments2011-12-31$96,141
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$1,185,905
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$1,185,905
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$2,648,108
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$3,040,959
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-361,725
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$1,337,462
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$10,478
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 name2011-12-31CROWE HORWATH
Accountancy firm EIN2011-12-31350921680
2010 : SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2010 401k financial data
Total transfer of assets from this plan2010-12-31$15,676
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$10,478
Total income from all sources (including contributions)2010-12-31$1,686,606
Total of all expenses incurred2010-12-31$1,211,118
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$1,203,415
Value of total assets at end of year2010-12-31$16,654,440
Value of total assets at beginning of year2010-12-31$16,184,150
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$7,703
Total interest from all sources2010-12-31$109,591
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$170,697
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$170,697
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$10,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Participant contributions at end of year2010-12-31$63,313
Participant contributions at beginning of year2010-12-31$67,514
Administrative expenses (other) incurred2010-12-31$7,703
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$475,488
Value of net assets at end of year (total assets less liabilities)2010-12-31$16,643,962
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$16,184,150
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 registered invesment companies (eg mutual funds) at end of year2010-12-31$12,364,263
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$11,512,940
Interest on participant loans2010-12-31$4,253
Interest earned on other investments2010-12-31$104,797
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$1,185,905
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$1,403,822
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$1,403,822
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$541
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$3,040,959
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$3,199,874
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$1,406,318
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$1,203,415
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Liabilities. Value of benefit claims payable at end of year2010-12-31$10,478
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 name2010-12-31PERRY-SMITH, LLP
Accountancy firm EIN2010-12-31680041802

Form 5500 Responses for SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN

2016: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01This submission is the final filingYes
2016-01-01This return/report is a short plan year return/report (less than 12 months)Yes
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: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
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: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
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: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
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: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedYes
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: SUMMIT MEDICAL CENTER CUSTOM SAVER PENSION PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number25959-071, 072
Policy instance 4
Insurance contract or identification number25959-071, 072
Number of Individuals Covered38
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 $629
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees629
Additional information about fees paid to insurance brokerOTHER FEES FOR SERVICE
Insurance broker organization code?3
Insurance broker nameFIDELITY INSURANCE AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number006115
Policy instance 3
Insurance contract or identification number006115
Number of Individuals Covered42
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
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE8172/8173
Policy instance 2
Insurance contract or identification numberVE8172/8173
Number of Individuals Covered55
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $344
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $344
Insurance broker organization code?3
Insurance broker nameMACIOCI LINDA
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberL677E053 90053
Policy instance 1
Insurance contract or identification numberL677E053 90053
Number of Individuals Covered157
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,509
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,509
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameWOODBURY FINANCIAL SERVICES INC.
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number25959-071, 072
Policy instance 4
Insurance contract or identification number25959-071, 072
Number of Individuals Covered47
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
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE8172/8173
Policy instance 2
Insurance contract or identification numberVE8172/8173
Number of Individuals Covered33
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $427
Total amount of fees paid to insurance companyUSD $0
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $427
Insurance broker organization code?3
Insurance broker nameMACIOCI LINDA
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberL677E053 90053
Policy instance 1
Insurance contract or identification numberL677E053 90053
Number of Individuals Covered172
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,745
Total amount of fees paid to insurance companyUSD $0
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 guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,745
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameWOODBURY FINANCIAL SERVICES INC.
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number006115
Policy instance 3
Insurance contract or identification number006115
Number of Individuals Covered95
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
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE8172/8173
Policy instance 2
Insurance contract or identification numberVE8172/8173
Number of Individuals Covered35
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $419
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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
Commission paid to Insurance BrokerUSD $419
Insurance broker organization code?3
Insurance broker nameMACIOCI LINDA
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberL677E053 90053
Policy instance 3
Insurance contract or identification numberL677E053 90053
Number of Individuals Covered192
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,662
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?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
Commission paid to Insurance BrokerUSD $4,662
Insurance broker organization code?3
Insurance broker nameWOODBURY FINANCIAL SERVICES INC.
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number006115
Policy instance 4
Insurance contract or identification number006115
Number of Individuals Covered103
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
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number25959-071/072
Policy instance 1
Insurance contract or identification number25959-071/072
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 $656
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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
Amount paid for insurance broker fees656
Additional information about fees paid to insurance brokerINSURANCE FEES
Insurance broker organization code?3
Insurance broker nameFIDELITY INSURANCE AGENCY
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number25959-071/072
Policy instance 1
Insurance contract or identification number25959-071/072
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $818
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number25959-071/072
Policy instance 3
Insurance contract or identification number25959-071/072
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $816
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
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
Commission paid to Insurance BrokerUSD $816
Additional information about fees paid to insurance brokerINSURANCE FEES
Insurance broker organization code?3
Insurance broker nameFIDELITY INSURANCE AGENCY
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE0771/8172-73
Policy instance 1
Insurance contract or identification numberVE0771/8172-73
Number of Individuals Covered73
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $490
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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
Commission paid to Insurance BrokerUSD $490
Insurance broker organization code?3
Insurance broker nameMACIOCI LINDA
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberL677E053 90053
Policy instance 4
Insurance contract or identification numberL677E053 90053
Number of Individuals Covered211
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?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
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker name
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE0771/8172-73
Policy instance 3
Insurance contract or identification numberVE0771/8172-73
Number of Individuals Covered73
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $490
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number006115
Policy instance 2
Insurance contract or identification number006115
Number of Individuals Covered107
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
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
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number006115
Policy instance 3
Insurance contract or identification number006115
Number of Individuals Covered110
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number25959-071/072
Policy instance 2
Insurance contract or identification number25959-071/072
Number of Individuals Covered477
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $910
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE8172/VE8173
Policy instance 1
Insurance contract or identification numberVE8172/VE8173
Number of Individuals Covered81
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $664
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberL677E053 90053
Policy instance 4
Insurance contract or identification numberL677E053 90053
Number of Individuals Covered230
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,813
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE8172/VE8173
Policy instance 4
Insurance contract or identification numberVE8172/VE8173
Number of Individuals Covered80
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $754
Total amount of fees paid to insurance companyUSD $8
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $754
Amount paid for insurance broker fees8
Additional information about fees paid to insurance brokerSUPPLEMENTAL CASH PAID
Insurance broker organization code?3
Insurance broker nameMACIOCI LINDA
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number25959-071/072
Policy instance 3
Insurance contract or identification number25959-071/072
Number of Individuals Covered498
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,004
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1004
Additional information about fees paid to insurance brokerINSURANCE FEES
Insurance broker organization code?3
Insurance broker nameFIDELITY INSURANCE AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number006115
Policy instance 1
Insurance contract or identification number006115
Number of Individuals Covered113
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberL677E053 90053
Policy instance 2
Insurance contract or identification numberL677E053 90053
Number of Individuals Covered254
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,988
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,988
Insurance broker organization code?3
Insurance broker nameWOODBURY FINANCIAL SERVICES, INC.

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