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CLEARFIELD HOSPITAL RETIREMENT PLAN 401k Plan overview

Plan NameCLEARFIELD HOSPITAL RETIREMENT PLAN
Plan identification number 003

CLEARFIELD HOSPITAL RETIREMENT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Money purchase (other than target benefit)
  • 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.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

DUBOIS REGIONAL MEDICAL CENTER INC has sponsored the creation of one or more 401k plans.

Company Name:DUBOIS REGIONAL MEDICAL CENTER INC
Employer identification number (EIN):251490707
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CLEARFIELD HOSPITAL RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032023-01-01
0032022-01-01
0032021-01-01

Plan Statistics for CLEARFIELD HOSPITAL RETIREMENT PLAN

401k plan membership statisitcs for CLEARFIELD HOSPITAL RETIREMENT PLAN

Measure Date Value
2023: CLEARFIELD HOSPITAL RETIREMENT PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01266
Total number of active participants reported on line 7a of the Form 55002023-01-01130
Number of retired or separated participants receiving benefits2023-01-015
Number of other retired or separated participants entitled to future benefits2023-01-01110
Total of all active and inactive participants2023-01-01245
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2023-01-011
Total participants2023-01-01246
Number of participants with account balances2023-01-01246
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2023-01-010
2022: CLEARFIELD HOSPITAL RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01285
Total number of active participants reported on line 7a of the Form 55002022-01-01138
Number of retired or separated participants receiving benefits2022-01-015
Number of other retired or separated participants entitled to future benefits2022-01-01121
Total of all active and inactive participants2022-01-01264
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-012
Total participants2022-01-01266
Number of participants with account balances2022-01-01266
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: CLEARFIELD HOSPITAL RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01309
Total number of active participants reported on line 7a of the Form 55002021-01-01153
Number of retired or separated participants receiving benefits2021-01-014
Number of other retired or separated participants entitled to future benefits2021-01-01128
Total of all active and inactive participants2021-01-01285
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01285
Number of participants with account balances2021-01-01285
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010

Financial Data on CLEARFIELD HOSPITAL RETIREMENT PLAN

Measure Date Value
2023 : CLEARFIELD HOSPITAL RETIREMENT PLAN 2023 401k financial data
Total income from all sources (including contributions)2023-12-31$1,269,281
Total of all expenses incurred2023-12-31$787,524
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-12-31$760,668
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-12-31$14
Value of total assets at end of year2023-12-31$8,716,973
Value of total assets at beginning of year2023-12-31$8,235,216
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-12-31$26,856
Total interest from all sources2023-12-31$8,236
Total dividends received (eg from common stock, registered investment company shares)2023-12-31$195,986
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2023-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2023-12-31$195,986
Was this plan covered by a fidelity bond2023-12-31Yes
Value of fidelity bond cover2023-12-31$500,000
If this is an individual account plan, was there a blackout period2023-12-31No
Were there any nonexempt tranactions with any party-in-interest2023-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Value of net income/loss2023-12-31$481,757
Value of net assets at end of year (total assets less liabilities)2023-12-31$8,716,973
Value of net assets at beginning of year (total assets less liabilities)2023-12-31$8,235,216
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-12-31No
Were any leases to which the plan was party in default or uncollectible2023-12-31No
Investment advisory and management fees2023-12-31$16
Value of interest in registered invesment companies (eg mutual funds) at end of year2023-12-31$8,419,638
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2023-12-31$7,815,124
Interest earned on other investments2023-12-31$8,236
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2023-12-31$297,335
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2023-12-31$420,092
Net investment gain/loss from registered investment companies (e.g. mutual funds)2023-12-31$1,065,045
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-12-31No
Was there a failure to transmit to the plan any participant contributions2023-12-31No
Has the plan failed to provide any benefit when due under the plan2023-12-31No
Contributions received in cash from employer2023-12-31$14
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-12-31$760,668
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32023-12-31No
Did the plan have assets held for investment2023-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-12-31No
Opinion of an independent qualified public accountant for this plan2023-12-31Unqualified
Accountancy firm name2023-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2023-12-31410746749
2022 : CLEARFIELD HOSPITAL RETIREMENT PLAN 2022 401k financial data
Total income from all sources (including contributions)2022-12-31$-1,636,002
Total of all expenses incurred2022-12-31$693,503
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$644,527
Value of total assets at end of year2022-12-31$8,235,216
Value of total assets at beginning of year2022-12-31$10,564,721
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$48,976
Total interest from all sources2022-12-31$7,178
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$171,347
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$171,347
Administrative expenses professional fees incurred2022-12-31$31,682
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Administrative expenses (other) incurred2022-12-31$13,073
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-2,329,505
Value of net assets at end of year (total assets less liabilities)2022-12-31$8,235,216
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$10,564,721
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$4,221
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$7,815,124
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$10,296,186
Interest earned on other investments2022-12-31$7,178
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$420,092
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$268,535
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-1,814,527
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$644,527
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31PLANTE & MORAN, PLLC
Accountancy firm EIN2022-12-31381357951
2021 : CLEARFIELD HOSPITAL RETIREMENT PLAN 2021 401k financial data
Total income from all sources (including contributions)2021-12-31$1,202,700
Total of all expenses incurred2021-12-31$704,596
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$683,592
Value of total assets at end of year2021-12-31$10,564,721
Value of total assets at beginning of year2021-12-31$10,066,617
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$21,004
Total interest from all sources2021-12-31$5,461
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$177,676
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$177,676
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Funding deficiency by the employer to the plan for this plan year2021-12-31$0
Minimum employer required contribution for this plan year2021-12-31$0
Amount contributed by the employer to the plan for this plan year2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Administrative expenses (other) incurred2021-12-31$15,197
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$498,104
Value of net assets at end of year (total assets less liabilities)2021-12-31$10,564,721
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$10,066,617
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$5,807
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$10,296,186
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$9,803,405
Interest earned on other investments2021-12-31$5,461
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$268,535
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$263,212
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$1,019,563
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$683,592
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31FORVIS, LLP
Accountancy firm EIN2021-12-31440160260

Form 5500 Responses for CLEARFIELD HOSPITAL RETIREMENT PLAN

2023: CLEARFIELD HOSPITAL RETIREMENT PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – TrustYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement - TrustYes
2022: CLEARFIELD HOSPITAL RETIREMENT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: CLEARFIELD HOSPITAL RETIREMENT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract numberTA080566
Policy instance 1
Insurance contract or identification numberTA080566
Number of Individuals Covered246
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract numberTA080566
Policy instance 1
Insurance contract or identification numberTA080566
Number of Individuals Covered266
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
Policy contract numberTA080566
Policy instance 1
Insurance contract or identification numberTA080566
Number of Individuals Covered285
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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