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BLUE MOUNTAIN HOSPITAL 403(B) PLAN 401k Plan overview

Plan NameBLUE MOUNTAIN HOSPITAL 403(B) PLAN
Plan identification number 001

BLUE MOUNTAIN HOSPITAL 403(B) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

BLUE MOUNTAIN HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:BLUE MOUNTAIN HOSPITAL
Employer identification number (EIN):200743054
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUE MOUNTAIN HOSPITAL 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01DERRILL KENT TUREK2024-07-22
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01DERRILL KENT TUREK
0012017-01-01DERRILL KENT TUREK
0012016-01-01JIMMY JOHNSON
0012015-01-01JIMMY JOHNSON JIMMY JOHNSON2016-05-31
0012014-01-01JIMMY JOHNSON JIMMY JOHNSON2015-04-20
0012013-01-01JEREMY LYMAN JEREMY LYMAN2014-05-29
0012012-09-01JEREMY LYMAN JEREMY LYMAN2013-05-07

Plan Statistics for BLUE MOUNTAIN HOSPITAL 403(B) PLAN

401k plan membership statisitcs for BLUE MOUNTAIN HOSPITAL 403(B) PLAN

Measure Date Value
2022: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01157
Total number of active participants reported on line 7a of the Form 55002022-01-01138
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0112
Total of all active and inactive participants2022-01-01150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01150
Number of participants with account balances2022-01-0175
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01138
Total number of active participants reported on line 7a of the Form 55002021-01-01143
Number of retired or separated participants receiving benefits2021-01-012
Number of other retired or separated participants entitled to future benefits2021-01-0112
Total of all active and inactive participants2021-01-01157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01157
Number of participants with account balances2021-01-0173
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-011
2020: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01128
Total number of active participants reported on line 7a of the Form 55002020-01-01124
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0111
Total of all active and inactive participants2020-01-01135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01135
Number of participants with account balances2020-01-0165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01106
Total number of active participants reported on line 7a of the Form 55002019-01-01115
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0113
Total of all active and inactive participants2019-01-01128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01128
Number of participants with account balances2019-01-0163
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-012
2018: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0193
Total number of active participants reported on line 7a of the Form 55002018-01-0184
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0112
Total of all active and inactive participants2018-01-0196
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0196
Number of participants with account balances2018-01-0163
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-014
2017: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0197
Total number of active participants reported on line 7a of the Form 55002017-01-0187
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-016
Total of all active and inactive participants2017-01-0193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0193
Number of participants with account balances2017-01-0160
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-013
2016: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0189
Total number of active participants reported on line 7a of the Form 55002016-01-0186
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0111
Total of all active and inactive participants2016-01-0197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0197
Number of participants with account balances2016-01-0163
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0180
Total number of active participants reported on line 7a of the Form 55002015-01-0168
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0110
Total of all active and inactive participants2015-01-0178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0178
Number of participants with account balances2015-01-0157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-011
2014: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0187
Total number of active participants reported on line 7a of the Form 55002014-01-0170
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-016
Total of all active and inactive participants2014-01-0176
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0176
Number of participants with account balances2014-01-0144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-012
2013: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0182
Total number of active participants reported on line 7a of the Form 55002013-01-0184
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-013
Total of all active and inactive participants2013-01-0187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0187
Number of participants with account balances2013-01-0140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-011
2012: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year2012-09-0174
Total number of active participants reported on line 7a of the Form 55002012-09-0178
Number of retired or separated participants receiving benefits2012-09-010
Number of other retired or separated participants entitled to future benefits2012-09-011
Total of all active and inactive participants2012-09-0179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-09-010
Total participants2012-09-0179
Number of participants with account balances2012-09-0133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-09-011

Financial Data on BLUE MOUNTAIN HOSPITAL 403(B) PLAN

Measure Date Value
2022 : BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$31,204
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$105,159
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$75,104
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$471,879
Value of total assets at end of year2022-12-31$2,954,849
Value of total assets at beginning of year2022-12-31$3,028,804
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$30,055
Total interest from all sources2022-12-31$8,448
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$3,000,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$285,043
Participant contributions at end of year2022-12-31$166,423
Participant contributions at beginning of year2022-12-31$213,835
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$14,668
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-73,955
Value of net assets at end of year (total assets less liabilities)2022-12-31$2,954,849
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$3,028,804
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$2,726,651
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$2,730,964
Interest on participant loans2022-12-31$7,611
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$837
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$61,775
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$84,005
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-449,123
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$172,168
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$75,104
Contract administrator fees2022-12-31$30,055
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31DINGUS, ZARECOR AND ASSOCIATES PLLC
Accountancy firm EIN2022-12-31200079326
2021 : BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$2,377
Total income from all sources (including contributions)2021-12-31$725,015
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$143,090
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$114,172
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$433,748
Value of total assets at end of year2021-12-31$3,028,804
Value of total assets at beginning of year2021-12-31$2,449,256
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$28,918
Total interest from all sources2021-12-31$8,219
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$3,000,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$264,589
Participant contributions at end of year2021-12-31$213,835
Participant contributions at beginning of year2021-12-31$115,185
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$3,626
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$2,377
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$581,925
Value of net assets at end of year (total assets less liabilities)2021-12-31$3,028,804
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$2,446,879
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$2,730,964
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$2,260,266
Interest on participant loans2021-12-31$8,219
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$84,005
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$73,805
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$283,048
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31Yes
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$165,533
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$114,172
Contract administrator fees2021-12-31$28,918
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31WSRP, LLC
Accountancy firm EIN2021-12-31870517754
2020 : BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$2,377
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$715,230
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$36,181
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$12,663
Value of total corrective distributions2020-12-31$2,377
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$387,908
Value of total assets at end of year2020-12-31$2,449,256
Value of total assets at beginning of year2020-12-31$1,767,830
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$21,141
Total interest from all sources2020-12-31$5,947
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$3,000,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$236,656
Participant contributions at end of year2020-12-31$115,185
Participant contributions at beginning of year2020-12-31$90,059
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$6,854
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$2,377
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$679,049
Value of net assets at end of year (total assets less liabilities)2020-12-31$2,446,879
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$1,767,830
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$2,260,266
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$1,615,683
Interest on participant loans2020-12-31$5,947
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$73,805
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$62,088
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$321,375
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31Yes
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$144,398
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$12,663
Contract administrator fees2020-12-31$21,141
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31WSRP, LLC
Accountancy firm EIN2020-12-31870517754
2019 : BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2019 401k financial data
Total income from all sources2019-12-31$595,255
Expenses. Total of all expenses incurred2019-12-31$98,412
Benefits paid (including direct rollovers)2019-12-31$96,939
Total plan assets at end of year2019-12-31$1,767,830
Total plan assets at beginning of year2019-12-31$1,270,987
Value of fidelity bond covering the plan2019-12-31$3,000,000
Total contributions received or receivable from participants2019-12-31$193,093
Expenses. Other expenses not covered elsewhere2019-12-31$1,473
Other income received2019-12-31$278,938
Net income (gross income less expenses)2019-12-31$496,843
Net plan assets at end of year (total assets less liabilities)2019-12-31$1,767,830
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$1,270,987
Assets. Value of participant loans2019-12-31$90,059
Total contributions received or receivable from employer(s)2019-12-31$123,224
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2018 401k financial data
Total income from all sources2018-12-31$208,546
Expenses. Total of all expenses incurred2018-12-31$153,642
Benefits paid (including direct rollovers)2018-12-31$151,282
Total plan assets at end of year2018-12-31$1,270,987
Total plan assets at beginning of year2018-12-31$1,216,083
Value of fidelity bond covering the plan2018-12-31$3,000,000
Total contributions received or receivable from participants2018-12-31$185,604
Expenses. Other expenses not covered elsewhere2018-12-31$2,360
Noncash contributions received2018-12-31$-97,090
Net income (gross income less expenses)2018-12-31$54,904
Net plan assets at end of year (total assets less liabilities)2018-12-31$1,270,987
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$1,216,083
Assets. Value of participant loans2018-12-31$72,068
Total contributions received or receivable from employer(s)2018-12-31$120,032
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2017 401k financial data
Total income from all sources2017-12-31$385,278
Expenses. Total of all expenses incurred2017-12-31$39,693
Benefits paid (including direct rollovers)2017-12-31$37,691
Total plan assets at end of year2017-12-31$1,216,083
Total plan assets at beginning of year2017-12-31$870,498
Value of fidelity bond covering the plan2017-12-31$3,000,000
Total contributions received or receivable from participants2017-12-31$148,376
Other income received2017-12-31$128,504
Net income (gross income less expenses)2017-12-31$345,585
Net plan assets at end of year (total assets less liabilities)2017-12-31$1,216,083
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$870,498
Assets. Value of participant loans2017-12-31$88,195
Total contributions received or receivable from employer(s)2017-12-31$108,398
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$2,002
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2016 401k financial data
Total income from all sources2016-12-31$295,382
Expenses. Total of all expenses incurred2016-12-31$78,767
Benefits paid (including direct rollovers)2016-12-31$77,517
Total plan assets at end of year2016-12-31$870,498
Total plan assets at beginning of year2016-12-31$653,883
Value of fidelity bond covering the plan2016-12-31$3,000,000
Total contributions received or receivable from participants2016-12-31$144,389
Contributions received from other sources (not participants or employers)2016-12-31$1,453
Other income received2016-12-31$42,437
Net income (gross income less expenses)2016-12-31$216,615
Net plan assets at end of year (total assets less liabilities)2016-12-31$870,498
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$653,883
Assets. Value of participant loans2016-12-31$64,426
Total contributions received or receivable from employer(s)2016-12-31$107,103
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$1,250
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2015 401k financial data
Total income from all sources2015-12-31$196,323
Expenses. Total of all expenses incurred2015-12-31$69,876
Benefits paid (including direct rollovers)2015-12-31$69,876
Total plan assets at end of year2015-12-31$653,883
Total plan assets at beginning of year2015-12-31$527,436
Value of fidelity bond covering the plan2015-12-31$3,000,000
Total contributions received or receivable from participants2015-12-31$124,573
Other income received2015-12-31$-18,508
Net income (gross income less expenses)2015-12-31$126,447
Net plan assets at end of year (total assets less liabilities)2015-12-31$653,883
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$527,436
Assets. Value of participant loans2015-12-31$61,567
Total contributions received or receivable from employer(s)2015-12-31$90,258
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2014 401k financial data
Total income from all sources2014-12-31$262,992
Expenses. Total of all expenses incurred2014-12-31$10,373
Benefits paid (including direct rollovers)2014-12-31$10,373
Total plan assets at end of year2014-12-31$527,436
Total plan assets at beginning of year2014-12-31$274,817
Value of fidelity bond covering the plan2014-12-31$3,000,000
Total contributions received or receivable from participants2014-12-31$109,347
Contributions received from other sources (not participants or employers)2014-12-31$57,365
Other income received2014-12-31$17,798
Net income (gross income less expenses)2014-12-31$252,619
Net plan assets at end of year (total assets less liabilities)2014-12-31$527,436
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$274,817
Assets. Value of participant loans2014-12-31$12,625
Total contributions received or receivable from employer(s)2014-12-31$78,482
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2013 401k financial data
Total income from all sources2013-12-31$202,249
Expenses. Total of all expenses incurred2013-12-31$170
Benefits paid (including direct rollovers)2013-12-31$170
Total plan assets at end of year2013-12-31$274,817
Total plan assets at beginning of year2013-12-31$72,738
Value of fidelity bond covering the plan2013-12-31$3,000,000
Total contributions received or receivable from participants2013-12-31$94,708
Contributions received from other sources (not participants or employers)2013-12-31$11,707
Other income received2013-12-31$27,031
Net income (gross income less expenses)2013-12-31$202,079
Net plan assets at end of year (total assets less liabilities)2013-12-31$274,817
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$72,738
Total contributions received or receivable from employer(s)2013-12-31$68,803
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2012 401k financial data
Total income from all sources2012-12-31$72,738
Total plan assets at end of year2012-12-31$72,738
Total plan assets at beginning of year2012-12-31$0
Total contributions received or receivable from participants2012-12-31$19,717
Contributions received from other sources (not participants or employers)2012-12-31$36,476
Other income received2012-12-31$1,903
Net income (gross income less expenses)2012-12-31$72,738
Net plan assets at end of year (total assets less liabilities)2012-12-31$72,738
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$0
Total contributions received or receivable from employer(s)2012-12-31$14,642
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0

Form 5500 Responses for BLUE MOUNTAIN HOSPITAL 403(B) PLAN

2022: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: BLUE MOUNTAIN HOSPITAL 403(B) 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 – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: BLUE MOUNTAIN HOSPITAL 403(B) PLAN 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01First time form 5500 has been submittedYes
2012-09-01Submission has been amendedNo
2012-09-01This submission is the final filingNo
2012-09-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-09-01Plan is a collectively bargained planNo
2012-09-01Plan funding arrangement – TrustYes
2012-09-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number786-80081
Policy instance 1
Insurance contract or identification number786-80081
Number of Individuals Covered0
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number786-80081
Policy instance 1
Insurance contract or identification number786-80081
Number of Individuals Covered7
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number786-80081
Policy instance 1
Insurance contract or identification number786-80081
Number of Individuals Covered6
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number786-80081
Policy instance 1
Insurance contract or identification number786-80081
Number of Individuals Covered6
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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