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GOODALL HOSPITAL 403(B) RETIREMENT PLAN 401k Plan overview

Plan NameGOODALL HOSPITAL 403(B) RETIREMENT PLAN
Plan identification number 002

GOODALL HOSPITAL 403(B) RETIREMENT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
  • 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

HENRIETTA D. GOODALL HOSPITAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:HENRIETTA D. GOODALL HOSPITAL, INC.
Employer identification number (EIN):010078060
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GOODALL HOSPITAL 403(B) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022013-01-01YVONNE MCALLISTER
0022012-01-01CAROLYN BURGESS
0022011-01-01CAROLYN BURGESS
0022009-01-01CAROLYN BURGESS

Plan Statistics for GOODALL HOSPITAL 403(B) RETIREMENT PLAN

401k plan membership statisitcs for GOODALL HOSPITAL 403(B) RETIREMENT PLAN

Measure Date Value
2013
Total participants, beginning-of-year2013-01-011,127
Total number of active participants reported on line 7a of the Form 55002013-01-010
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-010
Number of participants with account balances2013-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012
Total participants, beginning-of-year2012-01-011,117
Total number of active participants reported on line 7a of the Form 55002012-01-01853
Number of retired or separated participants receiving benefits2012-01-011
Number of other retired or separated participants entitled to future benefits2012-01-01273
Total of all active and inactive participants2012-01-011,127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-011,127
Number of participants with account balances2012-01-011,070
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-0126
2011
Total participants, beginning-of-year2011-01-01887
Total number of active participants reported on line 7a of the Form 55002011-01-01852
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-01265
Total of all active and inactive participants2011-01-011,117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-011,117
Number of participants with account balances2011-01-011,023
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-0116
2009
Total participants, beginning-of-year2009-01-01711
Total number of active participants reported on line 7a of the Form 55002009-01-01689
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-014
Total of all active and inactive participants2009-01-01693
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-012
Total participants2009-01-01695
Number of participants with account balances2009-01-01695
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-0127

Financial Data on GOODALL HOSPITAL 403(B) RETIREMENT PLAN

Measure Date Value
2013
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total transfer of assets from this plan2013-12-31$18,293,241
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$258
Total income from all sources (including contributions)2013-12-31$4,195,777
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$1,147,650
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$1,105,946
Expenses. Certain deemed distributions of participant loans2013-12-31$39,773
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$1,718,812
Value of total assets at end of year2013-12-31$0
Value of total assets at beginning of year2013-12-31$15,245,372
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$1,931
Total interest from all sources2013-12-31$179,513
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$491,019
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$491,019
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$1,345,370
Participant contributions at end of year2013-12-31$0
Participant contributions at beginning of year2013-12-31$137,641
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$122,221
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$258
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$3,048,127
Value of net assets at end of year (total assets less liabilities)2013-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$15,245,114
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$10,547,966
Interest on participant loans2013-12-31$3,835
Interest earned on other investments2013-12-31$175,676
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$2
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$4,559,765
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$1,806,433
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$251,221
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$1,105,946
Contract administrator fees2013-12-31$1,931
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31Yes
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31FEELEY & DRISCOLL, P.C.
Accountancy firm EIN2013-12-31042684828
2012
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$258
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$12,918
Total income from all sources (including contributions)2012-12-31$3,439,598
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$973,002
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$971,452
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$1,966,251
Value of total assets at end of year2012-12-31$15,245,372
Value of total assets at beginning of year2012-12-31$12,791,436
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$1,550
Total interest from all sources2012-12-31$130,576
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$132,343
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$132,343
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$1,322,601
Participant contributions at end of year2012-12-31$137,641
Participant contributions at beginning of year2012-12-31$164,263
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$275,923
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$12,918
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$258
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$12,918
Total non interest bearing cash at beginning of year2012-12-31$128
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$2,466,596
Value of net assets at end of year (total assets less liabilities)2012-12-31$15,245,114
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$12,778,518
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$10,547,966
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$8,608,211
Interest on participant loans2012-12-31$3,746
Interest earned on other investments2012-12-31$126,827
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$17,074
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$17,074
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$4,559,765
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$3,988,842
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$1,210,428
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$367,727
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$971,452
Contract administrator fees2012-12-31$1,550
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 name2012-12-31FEELEY & DRISCOLL, P.C.
Accountancy firm EIN2012-12-31042684828
2011
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total transfer of assets to this plan2011-12-31$1,913,819
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$12,918
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$39,522
Total income from all sources (including contributions)2011-12-31$1,663,202
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$1,238,405
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$1,236,680
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$1,742,889
Value of total assets at end of year2011-12-31$12,791,436
Value of total assets at beginning of year2011-12-31$10,479,424
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$1,725
Total interest from all sources2011-12-31$118,680
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$211,422
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$211,422
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$1,306,116
Participant contributions at end of year2011-12-31$164,263
Participant contributions at beginning of year2011-12-31$141,568
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$54,293
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$12,918
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$11,636
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$12,918
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$11,636
Total non interest bearing cash at end of year2011-12-31$128
Total non interest bearing cash at beginning of year2011-12-31$128
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$424,797
Value of net assets at end of year (total assets less liabilities)2011-12-31$12,778,518
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$10,439,902
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$8,608,211
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$7,413,176
Interest on participant loans2011-12-31$6,304
Interest earned on other investments2011-12-31$112,374
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$17,074
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$33,909
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$33,909
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$2
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$3,988,842
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$2,879,007
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-409,789
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$382,480
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$1,236,680
Contract administrator fees2011-12-31$1,725
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$27,886
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 name2011-12-31FEELEY & DRISCOLL, P.C.
Accountancy firm EIN2011-12-31042684828
2010
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$39,522
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$59,698
Total income from all sources (including contributions)2010-12-31$2,549,424
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$660,577
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$656,700
Value of total corrective distributions2010-12-31$2,789
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$1,534,495
Value of total assets at end of year2010-12-31$10,479,424
Value of total assets at beginning of year2010-12-31$8,610,753
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$1,088
Total interest from all sources2010-12-31$89,884
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$156,645
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$156,645
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 period2010-12-31Yes
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$1,189,187
Participant contributions at end of year2010-12-31$141,568
Participant contributions at beginning of year2010-12-31$104,894
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$139,106
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$11,636
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$11,301
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$11,636
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$59,698
Total non interest bearing cash at end of year2010-12-31$128
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$1,888,847
Value of net assets at end of year (total assets less liabilities)2010-12-31$10,439,902
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$8,551,055
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$7,413,176
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$6,026,656
Interest on participant loans2010-12-31$5,086
Interest earned on other investments2010-12-31$84,796
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$33,909
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$2,879,007
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$2,467,474
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$768,400
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$206,202
Employer contributions (assets) at beginning of year2010-12-31$428
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$656,700
Contract administrator fees2010-12-31$1,088
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31Yes
Liabilities. Value of benefit claims payable at end of year2010-12-31$27,886
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 name2010-12-31FEELEY & DRISCOLL, P.C.
Accountancy firm EIN2010-12-31042684828
2009
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses

2013
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingYes
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
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
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
2009
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

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number891999-001
Policy instance 3
Insurance contract or identification number891999-001
Number of Individuals Covered0
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number195181-001
Policy instance 2
Insurance contract or identification number195181-001
Number of Individuals Covered0
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number892594-007
Policy instance 1
Insurance contract or identification number892594-007
Number of Individuals Covered0
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number892594007
Policy instance 1
Insurance contract or identification number892594007
Number of Individuals Covered863
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number891999-001
Policy instance 3
Insurance contract or identification number891999-001
Number of Individuals Covered16
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number195181-001
Policy instance 2
Insurance contract or identification number195181-001
Number of Individuals Covered351
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number892594007
Policy instance 1
Insurance contract or identification number892594007
Number of Individuals Covered800
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number195181-001
Policy instance 2
Insurance contract or identification number195181-001
Number of Individuals Covered377
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number891999-001
Policy instance 3
Insurance contract or identification number891999-001
Number of Individuals Covered19
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number892594007
Policy instance 1
Insurance contract or identification number892594007
Number of Individuals Covered740
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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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