401k Plan data: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN plan

SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 401k Plan overview

Plan Name	SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN
Plan identification number	004

SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

UPMC HAMOT has sponsored the creation of one or more 401k plans.

Company Name: UPMC HAMOT

Employer identification number (EIN): 250965387

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about UPMC HAMOT

Jurisdiction of Incorporation: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE

Incorporation Date:

Company Identification Number: 152273

More information about UPMC HAMOT

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
004 2019-01-01
004 2019-01-01
004 2018-01-01 REBECCA HOVER
004 2017-01-01 REBECCA HOVER
004 2016-01-01 REBECCA HOVER

Plan Statistics for SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN

401k plan membership statisitcs for SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN

Measure Date Value
2019: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 0
Number of participants with account balances 2019-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 1
2018: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 102
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 33
Total of all active and inactive participants 2018-01-01 135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 135
Number of participants with account balances 2018-01-01 91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 177
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 116
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 39
Total of all active and inactive participants 2017-01-01 155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 155
Number of participants with account balances 2017-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 6
2016: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 222
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 143
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 34
Total of all active and inactive participants 2016-01-01 177
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 177
Number of participants with account balances 2016-01-01 117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 11

Measure	Date	Value
2019: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	0
Number of participants with account balances	2019-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	1
2018: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	102
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	33
Total of all active and inactive participants	2018-01-01	135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	135
Number of participants with account balances	2018-01-01	91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	177
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	116
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	39
Total of all active and inactive participants	2017-01-01	155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	155
Number of participants with account balances	2017-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	6
2016: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	222
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	143
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	34
Total of all active and inactive participants	2016-01-01	177
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	177
Number of participants with account balances	2016-01-01	117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	11

Financial Data on SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN

Measure	Date	Value
2019 : SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-11-05	$0
Total transfer of assets from this plan	2019-11-05	$2,464,062
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-11-05	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-11-05	$0
Total income from all sources (including contributions)	2019-11-05	$356,974
Total loss/gain on sale of assets	2019-11-05	$0
Total of all expenses incurred	2019-11-05	$251,508
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-11-05	$240,824
Expenses. Certain deemed distributions of participant loans	2019-11-05	$3,437
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-11-05	$0
Value of total assets at end of year	2019-11-05	$0
Value of total assets at beginning of year	2019-11-05	$2,358,596
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-11-05	$7,247
Total interest from all sources	2019-11-05	$552
Total dividends received (eg from common stock, registered investment company shares)	2019-11-05	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-11-05	No
Was this plan covered by a fidelity bond	2019-11-05	Yes
Value of fidelity bond cover	2019-11-05	$500,000
If this is an individual account plan, was there a blackout period	2019-11-05	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-11-05	$0
Were there any nonexempt tranactions with any party-in-interest	2019-11-05	No
Participant contributions at end of year	2019-11-05	$0
Participant contributions at beginning of year	2019-11-05	$16,578
Participant contributions at end of year	2019-11-05	$0
Participant contributions at beginning of year	2019-11-05	$0
Total non interest bearing cash at end of year	2019-11-05	$0
Total non interest bearing cash at beginning of year	2019-11-05	$22,122
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-11-05	No
Value of net income/loss	2019-11-05	$105,466
Value of net assets at end of year (total assets less liabilities)	2019-11-05	$0
Value of net assets at beginning of year (total assets less liabilities)	2019-11-05	$2,358,596
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-11-05	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-11-05	No
Were any leases to which the plan was party in default or uncollectible	2019-11-05	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-11-05	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-11-05	$0
Value of interest in pooled separate accounts at end of year	2019-11-05	$0
Value of interest in pooled separate accounts at beginning of year	2019-11-05	$2,296,430
Interest on participant loans	2019-11-05	$463
Interest earned on other investments	2019-11-05	$89
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-11-05	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-11-05	$23,466
Net investment gain/loss from pooled separate accounts	2019-11-05	$356,422
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-11-05	No
Was there a failure to transmit to the plan any participant contributions	2019-11-05	No
Has the plan failed to provide any benefit when due under the plan	2019-11-05	No
Employer contributions (assets) at end of year	2019-11-05	$0
Employer contributions (assets) at beginning of year	2019-11-05	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-11-05	$240,824
Contract administrator fees	2019-11-05	$7,247
Did the plan have assets held for investment	2019-11-05	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-11-05	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-11-05	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-11-05	Yes
Opinion of an independent qualified public accountant for this plan	2019-11-05	Disclaimer
Accountancy firm name	2019-11-05	MCGILL POWER BELL & ASSOCIATES
Accountancy firm EIN	2019-11-05	252972165
2018 : SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$-176,133
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$147,536
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$143,675
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$0
Value of total assets at end of year	2018-12-31	$2,358,596
Value of total assets at beginning of year	2018-12-31	$2,682,265
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$3,861
Total interest from all sources	2018-12-31	$1,068
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Participant contributions at end of year	2018-12-31	$16,578
Participant contributions at beginning of year	2018-12-31	$25,789
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$0
Total non interest bearing cash at end of year	2018-12-31	$22,122
Total non interest bearing cash at beginning of year	2018-12-31	$20,504
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-323,669
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$2,358,596
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,682,265
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$0
Value of interest in pooled separate accounts at end of year	2018-12-31	$2,296,430
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$2,614,142
Interest on participant loans	2018-12-31	$915
Interest earned on other investments	2018-12-31	$153
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$23,466
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$21,830
Net investment gain/loss from pooled separate accounts	2018-12-31	$-177,201
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Employer contributions (assets) at end of year	2018-12-31	$0
Employer contributions (assets) at beginning of year	2018-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$143,675
Contract administrator fees	2018-12-31	$3,861
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	MCGILL POWER BELL & ASSOCIATES
Accountancy firm EIN	2018-12-31	252972165
2017 : SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$385,804
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$454,225
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$446,195
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$0
Value of total assets at end of year	2017-12-31	$2,682,265
Value of total assets at beginning of year	2017-12-31	$2,750,686
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$8,030
Total interest from all sources	2017-12-31	$1,533
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Participant contributions at end of year	2017-12-31	$25,789
Participant contributions at beginning of year	2017-12-31	$40,900
Participant contributions at end of year	2017-12-31	$0
Participant contributions at beginning of year	2017-12-31	$0
Total non interest bearing cash at end of year	2017-12-31	$20,504
Total non interest bearing cash at beginning of year	2017-12-31	$1,841
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$-68,421
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$2,682,265
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,750,686
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$0
Value of interest in pooled separate accounts at end of year	2017-12-31	$2,614,142
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$2,684,838
Income. Interest from loans (other than to participants)	2017-12-31	$1,381
Interest earned on other investments	2017-12-31	$152
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$21,830
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$23,107
Net investment gain/loss from pooled separate accounts	2017-12-31	$384,271
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Employer contributions (assets) at end of year	2017-12-31	$0
Employer contributions (assets) at beginning of year	2017-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$446,195
Contract administrator fees	2017-12-31	$8,030
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	MCGILL POWER BELL & ASSOCIATES
Accountancy firm EIN	2017-12-31	252972165
2016 : SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$328,853
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$807,440
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$803,012
Expenses. Certain deemed distributions of participant loans	2016-12-31	$2,896
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$174,634
Value of total assets at end of year	2016-12-31	$2,750,686
Value of total assets at beginning of year	2016-12-31	$3,229,273
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$1,532
Total interest from all sources	2016-12-31	$1,900
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$127,360
Participant contributions at end of year	2016-12-31	$40,900
Participant contributions at beginning of year	2016-12-31	$43,670
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$4,957
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-478,587
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,750,686
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$3,229,273
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$0
Value of interest in pooled separate accounts at end of year	2016-12-31	$2,684,838
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$3,158,511
Income. Interest from loans (other than to participants)	2016-12-31	$1,900
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$23,107
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$21,394
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$21,394
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$1,841
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$5,698
Net investment gain/loss from pooled separate accounts	2016-12-31	$152,319
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$42,317
Employer contributions (assets) at end of year	2016-12-31	$0
Employer contributions (assets) at beginning of year	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$803,012
Contract administrator fees	2016-12-31	$1,532
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	K2S PC
Accountancy firm EIN	2016-12-31	251483438

Form 5500 Responses for SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN

2019: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	Yes
2019-01-01	This submission is the final filing	Yes
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

25732

Policy instance

Insurance contract or identification number	25732
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-11-05
Total amount of commissions paid to insurance broker	USD $5,774
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $5,677
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

25732

Policy instance

Insurance contract or identification number	25732
Number of Individuals Covered	106
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,753
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $6,455
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

25732

Policy instance

Insurance contract or identification number	25732
Number of Individuals Covered	117
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $7,731
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $6,428
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3
Insurance broker name	THE VARGO COMPANY

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Company Name:	UPMC HAMOT
Employer identification number (EIN):	250965387
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE
Incorporation Date:
Company Identification Number:	152273