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CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K) 401k Plan overview

Plan NameCHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K)
Plan identification number 004

CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K) Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • 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

CHILDREN'S WISCONSIN has sponsored the creation of one or more 401k plans.

Company Name:CHILDREN'S WISCONSIN
Employer identification number (EIN):391500074
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K)

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0042023-01-01
0042022-01-01
0042021-01-01

Plan Statistics for CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K)

401k plan membership statisitcs for CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K)

Measure Date Value
2023: CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K) 2023 401k membership
Total participants, beginning-of-year2023-01-01234
Total number of active participants reported on line 7a of the Form 55002023-01-01180
Number of retired or separated participants receiving benefits2023-01-011
Number of other retired or separated participants entitled to future benefits2023-01-0148
Total of all active and inactive participants2023-01-01229
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2023-01-010
Total participants2023-01-01229
Number of participants with account balances2023-01-01229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2023-01-010
2022: CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K) 2022 401k membership
Total participants, beginning-of-year2022-01-01218
Total number of active participants reported on line 7a of the Form 55002022-01-01187
Number of retired or separated participants receiving benefits2022-01-012
Number of other retired or separated participants entitled to future benefits2022-01-0145
Total of all active and inactive participants2022-01-01234
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01234
Number of participants with account balances2022-01-01230
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-011
2021: CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K) 2021 401k membership
Total participants, beginning-of-year2021-01-01213
Total number of active participants reported on line 7a of the Form 55002021-01-01175
Number of retired or separated participants receiving benefits2021-01-012
Number of other retired or separated participants entitled to future benefits2021-01-0141
Total of all active and inactive participants2021-01-01218
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01218
Number of participants with account balances2021-01-01213
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-011

Financial Data on CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K)

Measure Date Value
2023 : CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K) 2023 401k financial data
Unrealized appreciation/depreciation of real estate assets2023-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2023-12-31$0
Total unrealized appreciation/depreciation of assets2023-12-31$0
Total transfer of assets to this plan2023-12-31$0
Total transfer of assets from this plan2023-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$0
Expenses. Interest paid2023-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022023-12-31$0
Total income from all sources (including contributions)2023-12-31$5,734,648
Total loss/gain on sale of assets2023-12-31$0
Total of all expenses incurred2023-12-31$2,037,153
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-12-31$2,025,344
Expenses. Certain deemed distributions of participant loans2023-12-31$0
Value of total corrective distributions2023-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-12-31$2,471,280
Value of total assets at end of year2023-12-31$23,113,658
Value of total assets at beginning of year2023-12-31$19,416,163
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-12-31$11,809
Total income from rents2023-12-31$0
Total interest from all sources2023-12-31$33,149
Total dividends received (eg from common stock, registered investment company shares)2023-12-31$622,522
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2023-12-31$622,522
Assets. Real estate other than employer real property at end of year2023-12-31$0
Assets. Real estate other than employer real property at beginning of year2023-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2023-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2023-12-31$0
Was this plan covered by a fidelity bond2023-12-31Yes
Value of fidelity bond cover2023-12-31$1,500,000
If this is an individual account plan, was there a blackout period2023-12-31No
Were there any nonexempt tranactions with any party-in-interest2023-12-31No
Contributions received from participants2023-12-31$1,463,511
Participant contributions at end of year2023-12-31$221,937
Participant contributions at beginning of year2023-12-31$264,108
Participant contributions at end of year2023-12-31$0
Participant contributions at beginning of year2023-12-31$83,939
Assets. Other investments not covered elsewhere at end of year2023-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2023-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2023-12-31$121,206
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2023-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-12-31$1,187
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-12-31$1,008
Assets. Loans (other than to participants) at end of year2023-12-31$0
Assets. Loans (other than to participants) at beginning of year2023-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2023-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2023-12-31$0
Other income not declared elsewhere2023-12-31$0
Administrative expenses (other) incurred2023-12-31$1,481
Liabilities. Value of operating payables at end of year2023-12-31$0
Liabilities. Value of operating payables at beginning of year2023-12-31$0
Total non interest bearing cash at end of year2023-12-31$0
Total non interest bearing cash at beginning of year2023-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Income. Non cash contributions2023-12-31$0
Value of net income/loss2023-12-31$3,697,495
Value of net assets at end of year (total assets less liabilities)2023-12-31$23,113,658
Value of net assets at beginning of year (total assets less liabilities)2023-12-31$19,416,163
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-12-31No
Were any leases to which the plan was party in default or uncollectible2023-12-31No
Assets. partnership/joint venture interests at end of year2023-12-31$0
Assets. partnership/joint venture interests at beginning of year2023-12-31$0
Investment advisory and management fees2023-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2023-12-31$21,124,146
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2023-12-31$17,388,694
Value of interest in pooled separate accounts at end of year2023-12-31$0
Value of interest in pooled separate accounts at beginning of year2023-12-31$0
Interest on participant loans2023-12-31$14,036
Income. Interest from loans (other than to participants)2023-12-31$0
Interest earned on other investments2023-12-31$19,003
Income. Interest from US Government securities2023-12-31$0
Income. Interest from corporate debt instruments2023-12-31$0
Value of interest in master investment trust accounts at end of year2023-12-31$0
Value of interest in master investment trust accounts at beginning of year2023-12-31$0
Value of interest in common/collective trusts at end of year2023-12-31$0
Value of interest in common/collective trusts at beginning of year2023-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2023-12-31$3,083
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2023-12-31$864
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2023-12-31$864
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2023-12-31$110
Assets. Value of investments in 103.12 investment entities at end of year2023-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2023-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2023-12-31$876,441
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2023-12-31$826,650
Expenses. Payments to insurance carriers foe the provision of benefits2023-12-31$0
Asset value of US Government securities at end of year2023-12-31$0
Asset value of US Government securities at beginning of year2023-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2023-12-31$2,607,697
Net investment gain/loss from pooled separate accounts2023-12-31$0
Net investment gain or loss from common/collective trusts2023-12-31$0
Net gain/loss from 103.12 investment entities2023-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-12-31No
Was there a failure to transmit to the plan any participant contributions2023-12-31No
Has the plan failed to provide any benefit when due under the plan2023-12-31No
Assets. Invements in employer securities at end of year2023-12-31$0
Assets. Invements in employer securities at beginning of year2023-12-31$0
Assets. Value of employer real property at end of year2023-12-31$0
Assets. Value of employer real property at beginning of year2023-12-31$0
Contributions received in cash from employer2023-12-31$886,563
Employer contributions (assets) at end of year2023-12-31$886,864
Employer contributions (assets) at beginning of year2023-12-31$850,900
Income. Dividends from preferred stock2023-12-31$0
Income. Dividends from common stock2023-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-12-31$2,025,344
Asset. Corporate debt instrument preferred debt at end of year2023-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2023-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2023-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2023-12-31$0
Contract administrator fees2023-12-31$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32023-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2023-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2023-12-31$0
Liabilities. Value of benefit claims payable at end of year2023-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2023-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2023-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2023-12-31$0
Did the plan have assets held for investment2023-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-12-31No
Aggregate proceeds on sale of assets2023-12-31$0
Aggregate carrying amount (costs) on sale of assets2023-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2023-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2023-12-31$0
Opinion of an independent qualified public accountant for this plan2023-12-31Unqualified
Accountancy firm name2023-12-31WIPFLI LLP
Accountancy firm EIN2023-12-31390758449
2022 : CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K) 2022 401k financial data
Unrealized appreciation/depreciation of real estate assets2022-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$0
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total transfer of assets to this plan2022-12-31$0
Total transfer of assets from this plan2022-12-31$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
Expenses. Interest paid2022-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022022-12-31$0
Total income from all sources (including contributions)2022-12-31$-888,350
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$1,708,101
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,687,257
Expenses. Certain deemed distributions of participant loans2022-12-31$5,409
Value of total corrective distributions2022-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$2,556,667
Value of total assets at end of year2022-12-31$19,416,163
Value of total assets at beginning of year2022-12-31$22,012,614
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$15,435
Total income from rents2022-12-31$0
Total interest from all sources2022-12-31$20,722
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$712,558
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$712,558
Assets. Real estate other than employer real property at end of year2022-12-31$0
Assets. Real estate other than employer real property at beginning of year2022-12-31$0
Administrative expenses professional fees incurred2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$1,500,000
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$1,466,456
Participant contributions at end of year2022-12-31$264,108
Participant contributions at beginning of year2022-12-31$269,052
Participant contributions at end of year2022-12-31$83,939
Participant contributions at beginning of year2022-12-31$0
Assets. Other investments not covered elsewhere at end of year2022-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$247,754
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$1,008
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$457
Assets. Loans (other than to participants) at end of year2022-12-31$0
Assets. Loans (other than to participants) at beginning of year2022-12-31$0
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
Other income not declared elsewhere2022-12-31$0
Administrative expenses (other) incurred2022-12-31$15,435
Liabilities. Value of operating payables at end of year2022-12-31$0
Liabilities. Value of operating payables at beginning of year2022-12-31$0
Total non interest bearing cash at end of year2022-12-31$0
Total non interest bearing cash 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
Income. Non cash contributions2022-12-31$0
Value of net income/loss2022-12-31$-2,596,451
Value of net assets at end of year (total assets less liabilities)2022-12-31$19,416,163
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$22,012,614
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
Assets. partnership/joint venture interests at end of year2022-12-31$0
Assets. partnership/joint venture interests at beginning of year2022-12-31$0
Investment advisory and management fees2022-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$17,388,694
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$20,472,997
Value of interest in pooled separate accounts at end of year2022-12-31$0
Value of interest in pooled separate accounts at beginning of year2022-12-31$0
Interest on participant loans2022-12-31$13,188
Income. Interest from loans (other than to participants)2022-12-31$0
Interest earned on other investments2022-12-31$7,519
Income. Interest from US Government securities2022-12-31$0
Income. Interest from corporate debt instruments2022-12-31$0
Value of interest in master investment trust accounts at end of year2022-12-31$0
Value of interest in master investment trust accounts at beginning of year2022-12-31$0
Value of interest in common/collective trusts at end of year2022-12-31$0
Value of interest in common/collective trusts at beginning of year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$864
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$11,274
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$11,274
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$15
Assets. Value of investments in 103.12 investment entities at end of year2022-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$826,650
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$503,279
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$0
Asset value of US Government securities at end of year2022-12-31$0
Asset value of US Government securities at beginning of year2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-4,178,297
Net investment gain/loss from pooled separate accounts2022-12-31$0
Net investment gain or loss from common/collective trusts2022-12-31$0
Net gain/loss from 103.12 investment entities2022-12-31$0
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
Assets. Invements in employer securities at end of year2022-12-31$0
Assets. Invements in employer securities at beginning of year2022-12-31$0
Assets. Value of employer real property at end of year2022-12-31$0
Assets. Value of employer real property at beginning of year2022-12-31$0
Contributions received in cash from employer2022-12-31$842,457
Employer contributions (assets) at end of year2022-12-31$850,900
Employer contributions (assets) at beginning of year2022-12-31$755,555
Income. Dividends from preferred stock2022-12-31$0
Income. Dividends from common stock2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,687,257
Asset. Corporate debt instrument preferred debt at end of year2022-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$0
Contract administrator fees2022-12-31$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$0
Liabilities. Value of benefit claims payable at end of year2022-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2022-12-31$0
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
Aggregate proceeds on sale of assets2022-12-31$0
Aggregate carrying amount (costs) on sale of assets2022-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2022-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2022-12-31$0
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31WIPFLI LLP
Accountancy firm EIN2022-12-31390758449
2021 : CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K) 2021 401k financial data
Unrealized appreciation/depreciation of real estate assets2021-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2021-12-31$0
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total transfer of assets to this plan2021-12-31$827,514
Total transfer of assets from this plan2021-12-31$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$0
Expenses. Interest paid2021-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022021-12-31$0
Total income from all sources (including contributions)2021-12-31$4,627,312
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$934,767
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$914,428
Expenses. Certain deemed distributions of participant loans2021-12-31$7,900
Value of total corrective distributions2021-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$2,195,963
Value of total assets at end of year2021-12-31$22,012,614
Value of total assets at beginning of year2021-12-31$17,492,555
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$12,439
Total income from rents2021-12-31$0
Total interest from all sources2021-12-31$17,423
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$650,507
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$650,507
Assets. Real estate other than employer real property at end of year2021-12-31$0
Assets. Real estate other than employer real property at beginning of year2021-12-31$0
Administrative expenses professional fees incurred2021-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2021-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2021-12-31$0
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$1,500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$1,290,805
Participant contributions at end of year2021-12-31$269,052
Participant contributions at beginning of year2021-12-31$250,359
Participant contributions at end of year2021-12-31$0
Participant contributions at beginning of year2021-12-31$0
Assets. Other investments not covered elsewhere at end of year2021-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2021-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$154,519
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$457
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$250
Assets. Loans (other than to participants) at end of year2021-12-31$0
Assets. Loans (other than to participants) at beginning of year2021-12-31$0
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$0
Other income not declared elsewhere2021-12-31$0
Administrative expenses (other) incurred2021-12-31$12,439
Liabilities. Value of operating payables at end of year2021-12-31$0
Liabilities. Value of operating payables at beginning of year2021-12-31$0
Total non interest bearing cash at end of year2021-12-31$0
Total non interest bearing cash at beginning of year2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Income. Non cash contributions2021-12-31$0
Value of net income/loss2021-12-31$3,692,545
Value of net assets at end of year (total assets less liabilities)2021-12-31$22,012,614
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$17,492,555
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
Assets. partnership/joint venture interests at end of year2021-12-31$0
Assets. partnership/joint venture interests at beginning of year2021-12-31$0
Investment advisory and management fees2021-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$20,472,997
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$16,346,477
Value of interest in pooled separate accounts at end of year2021-12-31$0
Value of interest in pooled separate accounts at beginning of year2021-12-31$0
Interest on participant loans2021-12-31$13,173
Income. Interest from loans (other than to participants)2021-12-31$0
Interest earned on other investments2021-12-31$4,250
Income. Interest from US Government securities2021-12-31$0
Income. Interest from corporate debt instruments2021-12-31$0
Value of interest in master investment trust accounts at end of year2021-12-31$0
Value of interest in master investment trust accounts at beginning of year2021-12-31$0
Value of interest in common/collective trusts at end of year2021-12-31$0
Value of interest in common/collective trusts at beginning of year2021-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$11,274
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$40,006
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$40,006
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2021-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2021-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$503,279
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$198,661
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$0
Asset value of US Government securities at end of year2021-12-31$0
Asset value of US Government securities at beginning of year2021-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$1,763,419
Net investment gain/loss from pooled separate accounts2021-12-31$0
Net investment gain or loss from common/collective trusts2021-12-31$0
Net gain/loss from 103.12 investment entities2021-12-31$0
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 contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Assets. Invements in employer securities at end of year2021-12-31$0
Assets. Invements in employer securities at beginning of year2021-12-31$0
Assets. Value of employer real property at end of year2021-12-31$0
Assets. Value of employer real property at beginning of year2021-12-31$0
Contributions received in cash from employer2021-12-31$750,639
Employer contributions (assets) at end of year2021-12-31$755,555
Employer contributions (assets) at beginning of year2021-12-31$656,802
Income. Dividends from preferred stock2021-12-31$0
Income. Dividends from common stock2021-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$914,428
Asset. Corporate debt instrument preferred debt at end of year2021-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2021-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2021-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2021-12-31$0
Contract administrator fees2021-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2021-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2021-12-31$0
Liabilities. Value of benefit claims payable at end of year2021-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2021-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2021-12-31$0
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
Aggregate proceeds on sale of assets2021-12-31$0
Aggregate carrying amount (costs) on sale of assets2021-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2021-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2021-12-31$0
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31WIPFLI LLP
Accountancy firm EIN2021-12-31390758449

Form 5500 Responses for CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K)

2023: CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K) 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – TrustYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement - TrustYes
2022: CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K) 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: CHILDREN'S HOSPITAL AND HEALTH SYSTEM SHARED RETIREMENT SAVINGS PLAN - 401(K) 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

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number37580
Policy instance 1
Insurance contract or identification number37580
Number of Individuals Covered24
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number37580
Policy instance 1
Insurance contract or identification number37580
Number of Individuals Covered26
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number37580
Policy instance 1
Insurance contract or identification number37580
Number of Individuals Covered26
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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