401k Plan data: BLOOM HEALTH 401(K) PLAN plan

BLOOM HEALTH 401(K) PLAN 401k Plan overview

Plan Name	BLOOM HEALTH 401(K) PLAN
Plan identification number	001

BLOOM HEALTH 401(K) 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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.

401k Sponsoring company profile

BLOOM HEALTH CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: BLOOM HEALTH CORPORATION

Employer identification number (EIN): 271038374

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Additional information about BLOOM HEALTH CORPORATION

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 4733117

More information about BLOOM HEALTH CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLOOM HEALTH 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 RUSSELL GRUNDHAUSER
001 2015-01-01 RUSSELL GRUNDHAUSE
001 2014-01-01 SUE BELTT
001 2014-01-01 RUSSELL GRUNDHAUSER
001 2014-01-01 SUE BELTT
001 2013-01-01 SUE BELTT
001 2012-01-01 SARA EVANS 2013-06-20
001 2011-01-01 SARA EVANS 2012-06-06
001 2010-03-01 SARA EVANS 2011-07-28

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2016-01-01	RUSSELL GRUNDHAUSER
001	2015-01-01	RUSSELL GRUNDHAUSE
001	2014-01-01	SUE BELTT
001	2014-01-01	RUSSELL GRUNDHAUSER
001	2014-01-01	SUE BELTT
001	2013-01-01	SUE BELTT
001	2012-01-01	SARA EVANS	2013-06-20
001	2011-01-01	SARA EVANS	2012-06-06
001	2010-03-01	SARA EVANS	2011-07-28

Plan Statistics for BLOOM HEALTH 401(K) PLAN

401k plan membership statisitcs for BLOOM HEALTH 401(K) PLAN

Measure Date Value
2016: BLOOM HEALTH 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
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 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: BLOOM HEALTH 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 68
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 66
Total of all active and inactive participants 2015-01-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 134
Number of participants with account balances 2015-01-01 125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: BLOOM HEALTH 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 74
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 39
Total of all active and inactive participants 2014-01-01 113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 113
Number of participants with account balances 2014-01-01 106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: BLOOM HEALTH 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 87
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 109
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 21
Total of all active and inactive participants 2013-01-01 130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 130
Number of participants with account balances 2013-01-01 110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0

Measure	Date	Value
2016: BLOOM HEALTH 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
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	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: BLOOM HEALTH 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	68
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	66
Total of all active and inactive participants	2015-01-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	134
Number of participants with account balances	2015-01-01	125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: BLOOM HEALTH 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	74
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	39
Total of all active and inactive participants	2014-01-01	113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	113
Number of participants with account balances	2014-01-01	106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: BLOOM HEALTH 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	87
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	109
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	21
Total of all active and inactive participants	2013-01-01	130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	130
Number of participants with account balances	2013-01-01	110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0

Financial Data on BLOOM HEALTH 401(K) PLAN

Measure	Date	Value
2016 : BLOOM HEALTH 401(K) PLAN 2016 401k financial data
Unrealized appreciation/depreciation of real estate assets	2016-08-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2016-08-31	$0
Total unrealized appreciation/depreciation of assets	2016-08-31	$0
Total transfer of assets to this plan	2016-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-08-31	$0
Expenses. Interest paid	2016-08-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2016-08-31	$0
Total income from all sources (including contributions)	2016-08-31	$407,638
Total loss/gain on sale of assets	2016-08-31	$0
Total of all expenses incurred	2016-08-31	$2,527,570
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-08-31	$2,523,630
Expenses. Certain deemed distributions of participant loans	2016-08-31	$0
Value of total corrective distributions	2016-08-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-08-31	$260,717
Value of total assets at end of year	2016-08-31	$0
Value of total assets at beginning of year	2016-08-31	$2,119,932
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-08-31	$3,940
Total income from rents	2016-08-31	$0
Total interest from all sources	2016-08-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-08-31	$53,871
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-08-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-08-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2016-08-31	$53,871
Assets. Real estate other than employer real property at end of year	2016-08-31	$0
Assets. Real estate other than employer real property at beginning of year	2016-08-31	$0
Administrative expenses professional fees incurred	2016-08-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2016-08-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2016-08-31	$0
Was this plan covered by a fidelity bond	2016-08-31	Yes
Value of fidelity bond cover	2016-08-31	$500,000
If this is an individual account plan, was there a blackout period	2016-08-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-08-31	No
Contributions received from participants	2016-08-31	$260,717
Participant contributions at end of year	2016-08-31	$0
Participant contributions at beginning of year	2016-08-31	$0
Participant contributions at end of year	2016-08-31	$0
Participant contributions at beginning of year	2016-08-31	$0
Assets. Other investments not covered elsewhere at end of year	2016-08-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2016-08-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-08-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2016-08-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-08-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-08-31	$0
Assets. Loans (other than to participants) at end of year	2016-08-31	$0
Assets. Loans (other than to participants) at beginning of year	2016-08-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-08-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-08-31	$0
Other income not declared elsewhere	2016-08-31	$0
Administrative expenses (other) incurred	2016-08-31	$3,940
Liabilities. Value of operating payables at end of year	2016-08-31	$0
Liabilities. Value of operating payables at beginning of year	2016-08-31	$0
Total non interest bearing cash at end of year	2016-08-31	$0
Total non interest bearing cash at beginning of year	2016-08-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-08-31	No
Income. Non cash contributions	2016-08-31	$0
Value of net income/loss	2016-08-31	$-2,119,932
Value of net assets at end of year (total assets less liabilities)	2016-08-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-08-31	$2,119,932
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-08-31	No
Were any leases to which the plan was party in default or uncollectible	2016-08-31	No
Assets. partnership/joint venture interests at end of year	2016-08-31	$0
Assets. partnership/joint venture interests at beginning of year	2016-08-31	$0
Investment advisory and management fees	2016-08-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-08-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-08-31	$2,118,392
Value of interest in pooled separate accounts at end of year	2016-08-31	$0
Value of interest in pooled separate accounts at beginning of year	2016-08-31	$0
Interest on participant loans	2016-08-31	$0
Income. Interest from loans (other than to participants)	2016-08-31	$0
Interest earned on other investments	2016-08-31	$0
Income. Interest from US Government securities	2016-08-31	$0
Income. Interest from corporate debt instruments	2016-08-31	$0
Value of interest in master investment trust accounts at end of year	2016-08-31	$0
Value of interest in master investment trust accounts at beginning of year	2016-08-31	$0
Value of interest in common/collective trusts at end of year	2016-08-31	$0
Value of interest in common/collective trusts at beginning of year	2016-08-31	$1,540
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-08-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-08-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-08-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-08-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2016-08-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2016-08-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2016-08-31	$0
Asset value of US Government securities at end of year	2016-08-31	$0
Asset value of US Government securities at beginning of year	2016-08-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-08-31	$93,053
Net investment gain/loss from pooled separate accounts	2016-08-31	$0
Net investment gain or loss from common/collective trusts	2016-08-31	$-3
Net gain/loss from 103.12 investment entities	2016-08-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-08-31	No
Was there a failure to transmit to the plan any participant contributions	2016-08-31	No
Has the plan failed to provide any benefit when due under the plan	2016-08-31	No
Assets. Invements in employer securities at end of year	2016-08-31	$0
Assets. Invements in employer securities at beginning of year	2016-08-31	$0
Assets. Value of employer real property at end of year	2016-08-31	$0
Assets. Value of employer real property at beginning of year	2016-08-31	$0
Contributions received in cash from employer	2016-08-31	$0
Employer contributions (assets) at end of year	2016-08-31	$0
Employer contributions (assets) at beginning of year	2016-08-31	$0
Income. Dividends from preferred stock	2016-08-31	$0
Income. Dividends from common stock	2016-08-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-08-31	$2,523,630
Asset. Corporate debt instrument preferred debt at end of year	2016-08-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2016-08-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2016-08-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2016-08-31	$0
Contract administrator fees	2016-08-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-08-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2016-08-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2016-08-31	$0
Liabilities. Value of benefit claims payable at end of year	2016-08-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2016-08-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2016-08-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2016-08-31	$0
Did the plan have assets held for investment	2016-08-31	No
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	2016-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-08-31	Yes
Aggregate proceeds on sale of assets	2016-08-31	$0
Aggregate carrying amount (costs) on sale of assets	2016-08-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2016-08-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2016-08-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-08-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-08-31	Disclaimer
Accountancy firm name	2016-08-31	RSM US LLP
Accountancy firm EIN	2016-08-31	420714325
2015 : BLOOM HEALTH 401(K) PLAN 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets	2015-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2015-12-31	$0
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets to this plan	2015-12-31	$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
Expenses. Interest paid	2015-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$524,305
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$488,025
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$480,711
Expenses. Certain deemed distributions of participant loans	2015-12-31	$0
Value of total corrective distributions	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$540,828
Value of total assets at end of year	2015-12-31	$2,119,932
Value of total assets at beginning of year	2015-12-31	$2,083,652
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$7,314
Total income from rents	2015-12-31	$0
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$111,047
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$111,047
Assets. Real estate other than employer real property at end of year	2015-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2015-12-31	$0
Administrative expenses professional fees incurred	2015-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2015-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$540,828
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$0
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2015-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$0
Assets. Loans (other than to participants) at end of year	2015-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Other income not declared elsewhere	2015-12-31	$-26
Administrative expenses (other) incurred	2015-12-31	$7,314
Liabilities. Value of operating payables at end of year	2015-12-31	$0
Liabilities. Value of operating payables at beginning of year	2015-12-31	$0
Total non interest bearing cash at end of year	2015-12-31	$0
Total non interest bearing cash at beginning of year	2015-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Income. Non cash contributions	2015-12-31	$0
Value of net income/loss	2015-12-31	$36,280
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,119,932
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,083,652
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Assets. partnership/joint venture interests at end of year	2015-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2015-12-31	$0
Investment advisory and management fees	2015-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$2,118,392
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,082,128
Value of interest in pooled separate accounts at end of year	2015-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$0
Interest on participant loans	2015-12-31	$0
Income. Interest from loans (other than to participants)	2015-12-31	$0
Interest earned on other investments	2015-12-31	$0
Income. Interest from US Government securities	2015-12-31	$0
Income. Interest from corporate debt instruments	2015-12-31	$0
Value of interest in master investment trust accounts at end of year	2015-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2015-12-31	$0
Value of interest in common/collective trusts at end of year	2015-12-31	$1,540
Value of interest in common/collective trusts at beginning of year	2015-12-31	$1,524
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2015-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2015-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$0
Asset value of US Government securities at end of year	2015-12-31	$0
Asset value of US Government securities at beginning of year	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-127,560
Net investment gain/loss from pooled separate accounts	2015-12-31	$0
Net investment gain or loss from common/collective trusts	2015-12-31	$16
Net gain/loss from 103.12 investment entities	2015-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Assets. Invements in employer securities at end of year	2015-12-31	$0
Assets. Invements in employer securities at beginning of year	2015-12-31	$0
Assets. Value of employer real property at end of year	2015-12-31	$0
Assets. Value of employer real property at beginning of year	2015-12-31	$0
Contributions received in cash from employer	2015-12-31	$0
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$0
Income. Dividends from preferred stock	2015-12-31	$0
Income. Dividends from common stock	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$480,711
Asset. Corporate debt instrument preferred debt at end of year	2015-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2015-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2015-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2015-12-31	$0
Contract administrator fees	2015-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2015-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2015-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2015-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2015-12-31	$0
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Aggregate proceeds on sale of assets	2015-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2015-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2015-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2015-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	RSM US LLP
Accountancy firm EIN	2015-12-31	420714325
2014 : BLOOM HEALTH 401(K) PLAN 2014 401k financial data
Unrealized appreciation/depreciation of real estate assets	2014-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$0
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total transfer of assets to this plan	2014-12-31	$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
Expenses. Interest paid	2014-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$849,078
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$549,543
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$542,561
Expenses. Certain deemed distributions of participant loans	2014-12-31	$0
Value of total corrective distributions	2014-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$727,104
Value of total assets at end of year	2014-12-31	$2,083,652
Value of total assets at beginning of year	2014-12-31	$1,784,117
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$6,982
Total income from rents	2014-12-31	$0
Total interest from all sources	2014-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$137,688
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$137,688
Assets. Real estate other than employer real property at end of year	2014-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2014-12-31	$0
Administrative expenses professional fees incurred	2014-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2014-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$250,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$718,832
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$8,272
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$0
Assets. Loans (other than to participants) at end of year	2014-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$0
Other income not declared elsewhere	2014-12-31	$71
Administrative expenses (other) incurred	2014-12-31	$6,982
Liabilities. Value of operating payables at end of year	2014-12-31	$0
Liabilities. Value of operating payables at beginning of year	2014-12-31	$0
Total non interest bearing cash at end of year	2014-12-31	$0
Total non interest bearing cash at beginning of year	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Income. Non cash contributions	2014-12-31	$0
Value of net income/loss	2014-12-31	$299,535
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,083,652
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,784,117
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Assets. partnership/joint venture interests at end of year	2014-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2014-12-31	$0
Investment advisory and management fees	2014-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$2,082,128
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$1,777,092
Value of interest in pooled separate accounts at end of year	2014-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$0
Interest on participant loans	2014-12-31	$0
Income. Interest from loans (other than to participants)	2014-12-31	$0
Interest earned on other investments	2014-12-31	$0
Income. Interest from US Government securities	2014-12-31	$0
Income. Interest from corporate debt instruments	2014-12-31	$0
Value of interest in master investment trust accounts at end of year	2014-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2014-12-31	$0
Value of interest in common/collective trusts at end of year	2014-12-31	$1,524
Value of interest in common/collective trusts at beginning of year	2014-12-31	$34
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2014-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2014-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$6,991
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$0
Asset value of US Government securities at end of year	2014-12-31	$0
Asset value of US Government securities at beginning of year	2014-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$-15,820
Net investment gain/loss from pooled separate accounts	2014-12-31	$0
Net investment gain or loss from common/collective trusts	2014-12-31	$35
Net gain/loss from 103.12 investment entities	2014-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Assets. Invements in employer securities at end of year	2014-12-31	$0
Assets. Invements in employer securities at beginning of year	2014-12-31	$0
Assets. Value of employer real property at end of year	2014-12-31	$0
Assets. Value of employer real property at beginning of year	2014-12-31	$0
Contributions received in cash from employer	2014-12-31	$0
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$0
Income. Dividends from preferred stock	2014-12-31	$0
Income. Dividends from common stock	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$542,561
Asset. Corporate debt instrument preferred debt at end of year	2014-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2014-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2014-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2014-12-31	$0
Contract administrator fees	2014-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2014-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2014-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2014-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2014-12-31	$0
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Aggregate proceeds on sale of assets	2014-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2014-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2014-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2014-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	MCGLADREY LLP
Accountancy firm EIN	2014-12-31	420714325
2013 : BLOOM HEALTH 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$1,232,465
Expenses. Total of all expenses incurred	2013-12-31	$512,570
Benefits paid (including direct rollovers)	2013-12-31	$512,014
Total plan assets at end of year	2013-12-31	$1,784,117
Total plan assets at beginning of year	2013-12-31	$1,064,222
Value of fidelity bond covering the plan	2013-12-31	$250,000
Total contributions received or receivable from participants	2013-12-31	$683,900
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$248,490
Other income received	2013-12-31	$300,075
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$719,895
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,784,117
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,064,222
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$556
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0

Form 5500 Responses for BLOOM HEALTH 401(K) PLAN

2016: BLOOM HEALTH 401(K) 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	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: BLOOM HEALTH 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: BLOOM HEALTH 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: BLOOM HEALTH 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

942905-01

Policy instance

Insurance contract or identification number	942905-01
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-10-22
Total amount of commissions paid to insurance broker	USD $31
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare 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 $31
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JAMES MCQUILLAN LINSCO/PRIVATE

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

942905-01

Policy instance

Insurance contract or identification number	942905-01
Number of Individuals Covered	7
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,744
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare 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 $5,744
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JAMES MCQUILLAN LINSCO/PRIVATE

Potentially related plans

Was this data useful?

If you found the data here useful, PLEASE HELP US. We are a start-up and believe in making information freely available. By linking to us, posting on twitter, facebook and linkedin about us and generally spreading the word, you'll help us to grow. Our vision is to provide high quality data about the activities of all the companies in the world and where possible make it free to use and view. Finding and integrating data from thousands of data sources is time consuming and needs lots of effort. By simply spreading the word about us, you will help us. Please use the share buttons. It will only take a few seconds of your time. Thanks for helping

Information Disclaimer

The information provided on this website is not advice, endorsement or recommendation
The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
You are free to use the information for your own personal research on the understanding to do so is at your own risk.

See full terms and conditions

Company Name:	BLOOM HEALTH CORPORATION
Employer identification number (EIN):	271038374
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	4733117