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TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 401k Plan overview

Plan NameTAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME
Plan identification number 002

TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • 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

PENINSULA HOSPITAL CENTER AND PENINSULA GENERAL NURSING HOME has sponsored the creation of one or more 401k plans.

Company Name:PENINSULA HOSPITAL CENTER AND PENINSULA GENERAL NURSING HOME
Employer identification number (EIN):116037195
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022015-01-01CHRIS HULSE
0022014-01-01CHRIS HULSE
0022014-01-01CHRIS HULSE
0022013-01-01MONICA TERRANO
0022012-01-01MONICA TERRANO MONICA TERRANO2013-10-15
0022011-01-01MONICA TERRANO
0022010-01-01MONICA TERRANO
0022009-01-01KEVIN B. WESTLEY KEVIN B. WESTLEY2011-09-06
0022009-01-01KEVIN WESTLEY
0022009-01-01KEVIN WESTLEY

Plan Statistics for TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME

401k plan membership statisitcs for TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME

Measure Date Value
2015: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2015 401k membership
Total participants, beginning-of-year2015-01-01302
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-010
Number of participants with account balances2015-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2014 401k membership
Total participants, beginning-of-year2014-01-01580
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-016
Number of other retired or separated participants entitled to future benefits2014-01-01296
Total of all active and inactive participants2014-01-01302
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01302
Number of participants with account balances2014-01-01302
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2013 401k membership
Total participants, beginning-of-year2013-01-01652
Total number of active participants reported on line 7a of the Form 55002013-01-01425
Number of retired or separated participants receiving benefits2013-01-0115
Number of other retired or separated participants entitled to future benefits2013-01-01140
Total of all active and inactive participants2013-01-01580
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01580
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: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2012 401k membership
Total participants, beginning-of-year2012-01-01767
Total number of active participants reported on line 7a of the Form 55002012-01-01491
Number of retired or separated participants receiving benefits2012-01-0114
Number of other retired or separated participants entitled to future benefits2012-01-01147
Total of all active and inactive participants2012-01-01652
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01652
Number of participants with account balances2012-01-01652
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2011 401k membership
Total participants, beginning-of-year2011-01-01795
Total number of active participants reported on line 7a of the Form 55002011-01-01675
Number of retired or separated participants receiving benefits2011-01-0112
Number of other retired or separated participants entitled to future benefits2011-01-0180
Total of all active and inactive participants2011-01-01767
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01767
Number of participants with account balances2011-01-01767
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-01767
2010: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2010 401k membership
Total participants, beginning-of-year2010-01-01802
Total number of active participants reported on line 7a of the Form 55002010-01-01710
Number of retired or separated participants receiving benefits2010-01-0111
Number of other retired or separated participants entitled to future benefits2010-01-0174
Total of all active and inactive participants2010-01-01795
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-01795
Number of participants with account balances2010-01-01795
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2009 401k membership
Total participants, beginning-of-year2009-01-01707
Total number of active participants reported on line 7a of the Form 55002009-01-01707
Number of retired or separated participants receiving benefits2009-01-0125
Number of other retired or separated participants entitled to future benefits2009-01-0167
Total of all active and inactive participants2009-01-01799
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-013
Total participants2009-01-01802
Number of participants with account balances2009-01-01802
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME

Measure Date Value
2015 : TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$42,626
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$4,563,558
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$3,805,413
Expenses. Certain deemed distributions of participant loans2015-12-31$48,217
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$0
Value of total assets at end of year2015-12-31$0
Value of total assets at beginning of year2015-12-31$4,520,932
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$709,928
Total interest from all sources2015-12-31$6,155
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$1,390
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2015-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$1,390
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Participant contributions at end of year2015-12-31$0
Participant contributions at beginning of year2015-12-31$49,808
Administrative expenses (other) incurred2015-12-31$709,928
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-4,520,932
Value of net assets at end of year (total assets less liabilities)2015-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$4,520,932
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$1,433,151
Value of interest in pooled separate accounts at end of year2015-12-31$0
Value of interest in pooled separate accounts at beginning of year2015-12-31$450,089
Interest on participant loans2015-12-31$57
Interest earned on other investments2015-12-31$6,098
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$1,877,981
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$35,081
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Employer contributions (assets) at end of year2015-12-31$0
Employer contributions (assets) at beginning of year2015-12-31$709,903
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$3,805,413
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31BDO USA, INC.
Accountancy firm EIN2015-12-31135381590
2014 : TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$485,042
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$27,537,416
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$27,535,634
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$11,449
Value of total assets at end of year2014-12-31$4,520,932
Value of total assets at beginning of year2014-12-31$31,573,306
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$1,782
Total interest from all sources2014-12-31$247,564
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$54,148
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2014-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$54,148
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$11,449
Participant contributions at end of year2014-12-31$49,808
Participant contributions at beginning of year2014-12-31$287,717
Administrative expenses (other) incurred2014-12-31$1,782
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-27,052,374
Value of net assets at end of year (total assets less liabilities)2014-12-31$4,520,932
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$31,573,306
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$1,433,151
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$9,272,462
Value of interest in pooled separate accounts at end of year2014-12-31$450,089
Value of interest in pooled separate accounts at beginning of year2014-12-31$2,494,255
Interest on participant loans2014-12-31$6,395
Interest earned on other investments2014-12-31$241,169
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$1,877,981
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$18,808,969
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$171,881
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Employer contributions (assets) at end of year2014-12-31$709,903
Employer contributions (assets) at beginning of year2014-12-31$709,903
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$27,535,634
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31BDO USA, INC.
Accountancy firm EIN2014-12-31135381590
2013 : TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
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$0
Total income from all sources (including contributions)2013-12-31$3,269,596
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$6,530,536
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$6,383,905
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$104,974
Value of total assets at end of year2013-12-31$31,573,306
Value of total assets at beginning of year2013-12-31$34,834,246
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$146,631
Total interest from all sources2013-12-31$640,168
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$125,373
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$125,373
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 period2013-12-31No
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$104,974
Participant contributions at end of year2013-12-31$287,717
Participant contributions at beginning of year2013-12-31$387,475
Participant contributions at end of year2013-12-31$0
Participant contributions at beginning of year2013-12-31$5,064
Other income not declared elsewhere2013-12-31$141,945
Administrative expenses (other) incurred2013-12-31$146,631
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$-3,260,940
Value of net assets at end of year (total assets less liabilities)2013-12-31$31,573,306
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$34,834,246
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$9,272,462
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$8,602,534
Value of interest in pooled separate accounts at end of year2013-12-31$2,494,255
Value of interest in pooled separate accounts at beginning of year2013-12-31$2,449,934
Interest on participant loans2013-12-31$21,567
Interest earned on other investments2013-12-31$618,601
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$18,808,969
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$22,679,336
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$1,947,624
Net investment gain/loss from pooled separate accounts2013-12-31$309,512
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
Employer contributions (assets) at end of year2013-12-31$709,903
Employer contributions (assets) at beginning of year2013-12-31$709,903
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$6,383,905
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
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 name2013-12-31BDO USA, LLP
Accountancy firm EIN2013-12-31135381590
2012 : TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 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$0
Total income from all sources (including contributions)2012-12-31$3,807,377
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$17,969,320
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$17,956,644
Expenses. Certain deemed distributions of participant loans2012-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$840,808
Value of total assets at end of year2012-12-31$34,834,245
Value of total assets at beginning of year2012-12-31$48,996,188
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$12,676
Total interest from all sources2012-12-31$842,716
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$178,506
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$178,506
Administrative expenses professional fees incurred2012-12-31$1,772
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$594,655
Participant contributions at end of year2012-12-31$387,475
Participant contributions at beginning of year2012-12-31$477,606
Participant contributions at end of year2012-12-31$5,064
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$246,153
Administrative expenses (other) incurred2012-12-31$10,904
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$-14,161,943
Value of net assets at end of year (total assets less liabilities)2012-12-31$34,834,245
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$48,996,188
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$8,602,533
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$14,612,578
Value of interest in pooled separate accounts at end of year2012-12-31$2,449,934
Value of interest in pooled separate accounts at beginning of year2012-12-31$2,645,287
Interest on participant loans2012-12-31$25,890
Interest earned on other investments2012-12-31$816,826
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$120,712
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$120,712
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$22,679,336
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$30,430,102
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$1,690,823
Net investment gain/loss from pooled separate accounts2012-12-31$254,524
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 contributions2012-12-31Yes
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$0
Employer contributions (assets) at end of year2012-12-31$709,903
Employer contributions (assets) at beginning of year2012-12-31$709,903
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$17,956,644
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 name2012-12-31BDO USA, LLP
Accountancy firm EIN2012-12-31135381590
2011 : TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 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$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total income from all sources (including contributions)2011-12-31$1,752,395
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$5,654,580
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$5,640,359
Expenses. Certain deemed distributions of participant loans2011-12-31$11,657
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$1,234,366
Value of total assets at end of year2011-12-31$48,325,283
Value of total assets at beginning of year2011-12-31$52,227,468
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$2,564
Total interest from all sources2011-12-31$998,554
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$238,805
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$238,805
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$1,207,103
Participant contributions at end of year2011-12-31$516,605
Participant contributions at beginning of year2011-12-31$625,257
Participant contributions at beginning of year2011-12-31$160,863
Other income not declared elsewhere2011-12-31$259
Administrative expenses (other) incurred2011-12-31$2,564
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-3,902,185
Value of net assets at end of year (total assets less liabilities)2011-12-31$48,325,283
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$52,227,468
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$14,612,579
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$17,187,949
Value of interest in pooled separate accounts at end of year2011-12-31$2,645,287
Value of interest in pooled separate accounts at beginning of year2011-12-31$4,331,583
Interest on participant loans2011-12-31$35,048
Interest earned on other investments2011-12-31$963,461
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$120,710
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$45
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$30,430,102
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$29,499,733
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-721,224
Net investment gain/loss from pooled separate accounts2011-12-31$2,607
Net investment gain or loss from common/collective trusts2011-12-31$-972
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 contributions2011-12-31Yes
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$27,263
Employer contributions (assets) at end of year2011-12-31$709,903
Employer contributions (assets) at beginning of year2011-12-31$422,083
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$5,640,359
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 PBGC2011-12-31Yes
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 name2011-12-31BDO USA, LLP
Accountancy firm EIN2011-12-31135381590
2010 : TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 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$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$5,499,652
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$1,859,010
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$1,851,440
Expenses. Certain deemed distributions of participant loans2010-12-31$4,568
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$2,386,994
Value of total assets at end of year2010-12-31$50,452,700
Value of total assets at beginning of year2010-12-31$46,812,058
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$3,002
Total interest from all sources2010-12-31$958,194
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$185,984
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$185,984
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$1,962,012
Participant contributions at end of year2010-12-31$664,257
Participant contributions at beginning of year2010-12-31$606,329
Participant contributions at end of year2010-12-31$160,863
Participant contributions at beginning of year2010-12-31$33,097
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$1,390
Other income not declared elsewhere2010-12-31$9,479
Administrative expenses (other) incurred2010-12-31$3,002
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$3,640,642
Value of net assets at end of year (total assets less liabilities)2010-12-31$50,452,700
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$46,812,058
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$18,280,147
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$15,728,054
Value of interest in pooled separate accounts at end of year2010-12-31$2,008,563
Value of interest in pooled separate accounts at beginning of year2010-12-31$2,011,234
Interest on participant loans2010-12-31$37,554
Interest earned on other investments2010-12-31$919,959
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$681
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$29,499,733
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$28,466,441
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$1,768,343
Net investment gain/loss from pooled separate accounts2010-12-31$190,658
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$423,592
Employer contributions (assets) at end of year2010-12-31$422,083
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$1,851,440
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 PBGC2010-12-31Yes
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 name2010-12-31J.H. COHN LLP
Accountancy firm EIN2010-12-31221478099
2009 : TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 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 TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME

2015: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingYes
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedYes
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2012 form 5500 responses
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: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
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: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedYes
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: TAX DEFERRED RETIREMENT PLAN FOR EMPLOYEES OF PENINSULA HOSPITAL AND PENINSULA GENERAL NURSING HOME 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
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

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number007613
Policy instance 1
Insurance contract or identification number007613
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number007613
Policy instance 1
Insurance contract or identification number007613
Number of Individuals Covered302
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number007613
Policy instance 1
Insurance contract or identification number007613
Number of Individuals Covered580
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PLAN
Insurance broker organization code?4
Insurance broker name
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number007613
Policy instance 1
Insurance contract or identification number007613
Number of Individuals Covered652
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 $18,064
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees18064
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PLAN
Insurance broker organization code?4
Insurance broker nameCOMPREHENSIVE BROKERAGE SERVCS, INC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number007613
Policy instance 1
Insurance contract or identification number007613
Number of Individuals Covered767
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 $55,998
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number007613
Policy instance 1
Insurance contract or identification number007613
Number of Individuals Covered795
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 $52,555
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No

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