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THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN 401k Plan overview

Plan NameTHE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN
Plan identification number 002

THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • 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.

401k Sponsoring company profile

GOOD SAMARITAN HEALTH SERVICES FOUNDATION has sponsored the creation of one or more 401k plans.

Company Name:GOOD SAMARITAN HEALTH SERVICES FOUNDATION
Employer identification number (EIN):232356151
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022012-01-01KIMBERLY FEEMAN
0022011-01-01KIMBERLY FEEMAN
0022010-01-01KIMBERLY FEEMAN KIMBERLY FEEMAN2011-10-17
0022009-01-01KIMBERLY A. FEEMAN KIMBERLY A. FEEMAN2010-10-15

Plan Statistics for THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN

401k plan membership statisitcs for THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN

Measure Date Value
2012: THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,742
Total number of active participants reported on line 7a of the Form 55002012-01-011,504
Number of retired or separated participants receiving benefits2012-01-014
Number of other retired or separated participants entitled to future benefits2012-01-01223
Total of all active and inactive participants2012-01-011,731
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-011,731
Number of participants with account balances2012-01-011,029
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,655
Total number of active participants reported on line 7a of the Form 55002011-01-011,450
Number of retired or separated participants receiving benefits2011-01-012
Number of other retired or separated participants entitled to future benefits2011-01-01289
Total of all active and inactive participants2011-01-011,741
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-011
Total participants2011-01-011,742
Number of participants with account balances2011-01-01850
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-011,650
Total number of active participants reported on line 7a of the Form 55002010-01-011,401
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-01254
Total of all active and inactive participants2010-01-011,655
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-011,655
Number of participants with account balances2010-01-01740
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,708
Total number of active participants reported on line 7a of the Form 55002009-01-011,459
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-01191
Total of all active and inactive participants2009-01-011,650
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-011,650
Number of participants with account balances2009-01-01721
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN

Measure Date Value
2012 : THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$30,209
Total income from all sources (including contributions)2012-12-31$5,541,160
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$2,880,724
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$2,878,625
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$2,791,972
Value of total assets at end of year2012-12-31$29,025,491
Value of total assets at beginning of year2012-12-31$26,395,264
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$2,099
Total interest from all sources2012-12-31$288,936
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$275,060
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$275,060
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
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
Contributions received from participants2012-12-31$2,513,937
Participant contributions at end of year2012-12-31$169,283
Participant contributions at beginning of year2012-12-31$185,959
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$278,005
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$1
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$30,348
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$45,286
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$30,209
Total non interest bearing cash at end of year2012-12-31$2,293
Total non interest bearing cash at beginning of year2012-12-31$68
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$2,660,436
Value of net assets at end of year (total assets less liabilities)2012-12-31$29,025,491
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$26,365,055
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$19,227,151
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$16,584,100
Value of interest in pooled separate accounts at end of year2012-12-31$0
Value of interest in pooled separate accounts at beginning of year2012-12-31$384,511
Interest on participant loans2012-12-31$7,278
Interest earned on other investments2012-12-31$281,655
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$11,909
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$11,909
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$3
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$9,626,763
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$9,198,369
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$2,185,192
Net investment gain/loss from pooled separate accounts2012-12-31$11,669
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
Contributions received in cash from employer2012-12-31$30
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$2,878,625
Contract administrator fees2012-12-31$2,099
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31ERNST & YOUNG LLP
Accountancy firm EIN2012-12-31346565596
2011 : THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$30,209
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$24,404
Total income from all sources (including contributions)2011-12-31$2,152,816
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$2,040,673
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$2,038,529
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$2,594,013
Value of total assets at end of year2011-12-31$26,395,264
Value of total assets at beginning of year2011-12-31$26,277,316
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$2,144
Total interest from all sources2011-12-31$229,422
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$368,998
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$368,998
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$500,000
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$2,368,491
Participant contributions at end of year2011-12-31$185,959
Participant contributions at beginning of year2011-12-31$160,550
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$180,627
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$30,348
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$24,405
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$30,209
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$24,404
Total non interest bearing cash at end of year2011-12-31$68
Total non interest bearing cash at beginning of year2011-12-31$68
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$112,143
Value of net assets at end of year (total assets less liabilities)2011-12-31$26,365,055
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$26,252,912
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$16,584,100
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$17,503,003
Value of interest in pooled separate accounts at end of year2011-12-31$384,511
Value of interest in pooled separate accounts at beginning of year2011-12-31$423,443
Interest on participant loans2011-12-31$7,021
Interest earned on other investments2011-12-31$222,398
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$11,909
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$3,772
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$3,772
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$3
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$9,198,369
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$8,162,075
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-1,025,215
Net investment gain/loss from pooled separate accounts2011-12-31$-14,402
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$44,895
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$2,038,529
Contract administrator fees2011-12-31$2,144
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 name2011-12-31ERNST & YOUNG LLP
Accountancy firm EIN2011-12-31346565596
2010 : THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$24,404
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$93,586
Total income from all sources (including contributions)2010-12-31$5,124,550
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$1,763,848
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$1,761,502
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$2,597,060
Value of total assets at end of year2010-12-31$26,277,316
Value of total assets at beginning of year2010-12-31$22,985,796
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$2,346
Total interest from all sources2010-12-31$239,551
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$235,074
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$235,074
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$2,132,461
Participant contributions at end of year2010-12-31$160,550
Participant contributions at beginning of year2010-12-31$176,574
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$118,735
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$24,405
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$22,767
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$24,404
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$93,586
Total non interest bearing cash at end of year2010-12-31$68
Total non interest bearing cash at beginning of year2010-12-31$68
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$3,360,702
Value of net assets at end of year (total assets less liabilities)2010-12-31$26,252,912
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$22,892,210
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$17,503,003
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$15,857,952
Value of interest in pooled separate accounts at end of year2010-12-31$423,443
Interest on participant loans2010-12-31$6,308
Interest earned on other investments2010-12-31$233,241
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$3,772
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$73,762
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$73,762
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$2
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$8,162,075
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$6,854,673
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$2,005,005
Net investment gain/loss from pooled separate accounts2010-12-31$47,860
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$345,864
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$1,761,502
Contract administrator fees2010-12-31$2,346
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 name2010-12-31ERNST & YOUNG LLP
Accountancy firm EIN2010-12-31346565596
2009 : THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN

2012: THE GOOD SAMARITAN HOSPITAL TSA MATCHING 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: THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: THE GOOD SAMARITAN HOSPITAL TSA MATCHING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

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