401k Plan data: ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN plan

ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN 401k Plan overview

Plan Name	ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN
Plan identification number	002

ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	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.

401k Sponsoring company profile

ST. BERNARDS SCHOOL has sponsored the creation of one or more 401k plans.

Company Name: ST. BERNARDS SCHOOL

Employer identification number (EIN): 131255270

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01 EDWARD O'CONNELL
002 2015-01-01 EDWARD O'CONNELL
002 2014-01-01 EDWARD O'CONNELL
002 2013-01-01 EDWARD O'CONNELL 2014-07-28
002 2012-01-01 EDWARD O'CONNELL 2013-07-16
002 2011-01-01 EDWARD O'CONNELL 2012-10-10
002 2010-01-01 EDWARD O'CONNELL 2011-06-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2016-01-01	EDWARD O'CONNELL
002	2015-01-01	EDWARD O'CONNELL
002	2014-01-01	EDWARD O'CONNELL
002	2013-01-01	EDWARD O'CONNELL	2014-07-28
002	2012-01-01	EDWARD O'CONNELL	2013-07-16
002	2011-01-01	EDWARD O'CONNELL	2012-10-10
002	2010-01-01	EDWARD O'CONNELL	2011-06-09

Plan Statistics for ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN

401k plan membership statisitcs for ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN

Measure Date Value
2016: ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
2015: ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 94
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 36
Total of all active and inactive participants 2015-01-01 130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 130
Number of participants with account balances 2015-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 91
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 36
Total of all active and inactive participants 2014-01-01 127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 127
Number of participants with account balances 2014-01-01 89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2016: ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
2015: ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	94
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	36
Total of all active and inactive participants	2015-01-01	130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	130
Number of participants with account balances	2015-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	91
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	36
Total of all active and inactive participants	2014-01-01	127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	127
Number of participants with account balances	2014-01-01	89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN

Measure	Date	Value
2016 : ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total transfer of assets from this plan	2016-12-31	$10,428,600
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$1,168,972
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$368,032
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$368,032
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$595,639
Value of total assets at end of year	2016-12-31	$0
Value of total assets at beginning of year	2016-12-31	$9,627,660
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$0
Total interest from all sources	2016-12-31	$92,467
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$595,639
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$800,940
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$9,627,660
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$6,039,454
Value of interest in pooled separate accounts at end of year	2016-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$934,318
Interest earned on other investments	2016-12-31	$92,467
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$2,653,888
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$432,607
Net investment gain/loss from pooled separate accounts	2016-12-31	$48,259
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$368,032
Did the plan have assets held for investment	2016-12-31	No
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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	EISNERAMPER LLP
Accountancy firm EIN	2016-12-31	131639826
2015 : ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$897,103
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$360,536
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$360,536
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$748,469
Value of total assets at end of year	2015-12-31	$9,627,660
Value of total assets at beginning of year	2015-12-31	$9,091,093
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$0
Total interest from all sources	2015-12-31	$78,885
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$605,129
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$143,340
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$536,567
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$9,627,660
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$9,091,093
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$6,039,454
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$5,917,918
Value of interest in pooled separate accounts at end of year	2015-12-31	$934,318
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$755,129
Interest earned on other investments	2015-12-31	$78,885
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$2,653,888
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$2,418,046
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$4,584
Net investment gain/loss from pooled separate accounts	2015-12-31	$65,165
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$360,536
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	EISNERAMPER LLP
Accountancy firm EIN	2015-12-31	131639826
2014 : ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$1,365,578
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$647,949
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$647,949
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$869,110
Value of total assets at end of year	2014-12-31	$9,091,093
Value of total assets at beginning of year	2014-12-31	$8,373,464
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total interest from all sources	2014-12-31	$70,664
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$607,129
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$261,981
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$717,629
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$9,091,093
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$8,373,464
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$5,917,918
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$5,716,823
Value of interest in pooled separate accounts at end of year	2014-12-31	$755,129
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$463,265
Interest earned on other investments	2014-12-31	$70,664
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$2,418,046
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$2,193,376
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$362,323
Net investment gain/loss from pooled separate accounts	2014-12-31	$63,481
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$647,949
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	EISNERAMPER LLP
Accountancy firm EIN	2014-12-31	131639826

Form 5500 Responses for ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN

2016: ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: ST. BERNARDS SCHOOL TAX-DEFERRED ANNUITY PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )

Policy contract number

367178

Policy instance

Insurance contract or identification number	367178
Number of Individuals Covered	94
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )

Policy contract number

367178

Policy instance

Insurance contract or identification number	367178
Number of Individuals Covered	89
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

Potentially related plans

ST. BERNARDS PHYSICIAN CLINICS INC. RETIREMENT PLAN [EIN = 871439061]

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Company Name:	ST. BERNARDS SCHOOL
Employer identification number (EIN):	131255270
NAIC Classification:	611000