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SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 401k Plan overview

Plan NameSOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN
Plan identification number 002

SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN Benefits

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

401k Sponsoring company profile

SOUTH BEND MEDICAL FOUNDATION, INC has sponsored the creation of one or more 401k plans.

Company Name:SOUTH BEND MEDICAL FOUNDATION, INC
Employer identification number (EIN):350868178
NAIC Classification:621510
NAIC Description: Medical and Diagnostic Laboratories

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022022-01-01
0022021-01-01
0022020-01-01
0022019-01-01
0022018-01-01
0022017-01-01JIM FRAIN
0022016-01-01JIM FRAIN JIM FRAIN2017-10-12
0022015-01-01JIM FRAIN JIM FRAIN2016-08-17
0022014-01-01JIM FRAIN JIM FRAIN2015-10-13
0022013-01-01JIM FRAIN JIM FRAIN2014-09-16
0022012-01-01JIM FRAIN JIM FRAIN2013-09-17
0022011-01-01JIM FRAIN JIM FRAIN2012-10-03
0022010-01-01JIM FRAIN JIM FRAIN2011-12-19

Plan Statistics for SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN

401k plan membership statisitcs for SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN

Measure Date Value
2022: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01307
Total number of active participants reported on line 7a of the Form 55002022-01-01150
Number of retired or separated participants receiving benefits2022-01-0117
Number of other retired or separated participants entitled to future benefits2022-01-01117
Total of all active and inactive participants2022-01-01284
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-014
Total participants2022-01-01288
Number of participants with account balances2022-01-01249
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-011
2021: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01340
Total number of active participants reported on line 7a of the Form 55002021-01-01158
Number of retired or separated participants receiving benefits2021-01-0116
Number of other retired or separated participants entitled to future benefits2021-01-01129
Total of all active and inactive participants2021-01-01303
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-014
Total participants2021-01-01307
Number of participants with account balances2021-01-01279
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-014
2020: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01706
Total number of active participants reported on line 7a of the Form 55002020-01-01185
Number of retired or separated participants receiving benefits2020-01-017
Number of other retired or separated participants entitled to future benefits2020-01-01146
Total of all active and inactive participants2020-01-01338
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-011
Total participants2020-01-01339
Number of participants with account balances2020-01-01327
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-014
2019: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01757
Total number of active participants reported on line 7a of the Form 55002019-01-01496
Number of retired or separated participants receiving benefits2019-01-0115
Number of other retired or separated participants entitled to future benefits2019-01-01194
Total of all active and inactive participants2019-01-01705
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-011
Total participants2019-01-01706
Number of participants with account balances2019-01-01570
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-014
2018: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01753
Total number of active participants reported on line 7a of the Form 55002018-01-01576
Number of retired or separated participants receiving benefits2018-01-018
Number of other retired or separated participants entitled to future benefits2018-01-01173
Total of all active and inactive participants2018-01-01757
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01757
Number of participants with account balances2018-01-01568
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-015
2017: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01753
Total number of active participants reported on line 7a of the Form 55002017-01-01553
Number of retired or separated participants receiving benefits2017-01-012
Number of other retired or separated participants entitled to future benefits2017-01-01197
Total of all active and inactive participants2017-01-01752
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-011
Total participants2017-01-01753
Number of participants with account balances2017-01-01611
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-0110
2016: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01792
Total number of active participants reported on line 7a of the Form 55002016-01-01513
Number of retired or separated participants receiving benefits2016-01-011
Number of other retired or separated participants entitled to future benefits2016-01-01230
Total of all active and inactive participants2016-01-01744
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-019
Total participants2016-01-01753
Number of participants with account balances2016-01-01738
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-0111
2015: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01809
Total number of active participants reported on line 7a of the Form 55002015-01-01787
Number of retired or separated participants receiving benefits2015-01-011
Number of other retired or separated participants entitled to future benefits2015-01-01171
Total of all active and inactive participants2015-01-01959
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-018
Total participants2015-01-01967
Number of participants with account balances2015-01-01787
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-016
2014: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01810
Total number of active participants reported on line 7a of the Form 55002014-01-01665
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-01143
Total of all active and inactive participants2014-01-01808
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-017
Total participants2014-01-01815
Number of participants with account balances2014-01-01808
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-0119
2013: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01825
Total number of active participants reported on line 7a of the Form 55002013-01-01697
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-01114
Total of all active and inactive participants2013-01-01811
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-015
Total participants2013-01-01816
Number of participants with account balances2013-01-01810
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-0124
2012: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01747
Total number of active participants reported on line 7a of the Form 55002012-01-01701
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0140
Total of all active and inactive participants2012-01-01741
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-012
Total participants2012-01-01743
Number of participants with account balances2012-01-01738
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-0117
2011: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01376
Total number of active participants reported on line 7a of the Form 55002011-01-01718
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-013
Total of all active and inactive participants2011-01-01721
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-011
Total participants2011-01-01722
Number of participants with account balances2011-01-01719
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01223
Total number of active participants reported on line 7a of the Form 55002010-01-01374
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-011
Total of all active and inactive participants2010-01-01375
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-01375
Number of participants with account balances2010-01-01308
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010

Financial Data on SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN

Measure Date Value
2022 : SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2022 401k financial data
Total income from all sources (including contributions)2022-12-31$-2,174,190
Total of all expenses incurred2022-12-31$2,349,137
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$2,270,899
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$690,345
Value of total assets at end of year2022-12-31$15,083,667
Value of total assets at beginning of year2022-12-31$19,606,994
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$78,238
Total interest from all sources2022-12-31$62,066
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$246,641
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$246,641
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
Contributions received from participants2022-12-31$569,173
Participant contributions at end of year2022-12-31$56,785
Participant contributions at beginning of year2022-12-31$34,197
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$60,865
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$3
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Administrative expenses (other) incurred2022-12-31$45,695
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-4,523,327
Value of net assets at end of year (total assets less liabilities)2022-12-31$15,083,667
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$19,606,994
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$32,543
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$12,761,392
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$16,745,627
Value of interest in pooled separate accounts at end of year2022-12-31$109,318
Value of interest in pooled separate accounts at beginning of year2022-12-31$287,562
Interest on participant loans2022-12-31$1,941
Interest earned on other investments2022-12-31$60,125
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$2,156,169
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$2,539,608
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-3,115,625
Net investment gain/loss from pooled separate accounts2022-12-31$-57,617
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
Contributions received in cash from employer2022-12-31$60,307
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$2,270,899
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 plan2022-12-31Disclaimer
Accountancy firm name2022-12-31BLUE & CO., LLC
Accountancy firm EIN2022-12-31351178661
2021 : SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2021 401k financial data
Total income from all sources (including contributions)2021-12-31$2,858,754
Total of all expenses incurred2021-12-31$3,048,701
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$3,014,822
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$714,478
Value of total assets at end of year2021-12-31$19,606,994
Value of total assets at beginning of year2021-12-31$19,796,941
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$33,879
Total interest from all sources2021-12-31$61,150
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$258,920
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$258,920
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
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$657,712
Participant contributions at end of year2021-12-31$34,197
Participant contributions at beginning of year2021-12-31$49,969
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$6,355
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$323
Administrative expenses (other) incurred2021-12-31$33,879
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-189,947
Value of net assets at end of year (total assets less liabilities)2021-12-31$19,606,994
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$19,796,941
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$16,745,627
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$16,912,177
Value of interest in pooled separate accounts at end of year2021-12-31$287,562
Value of interest in pooled separate accounts at beginning of year2021-12-31$233,477
Interest on participant loans2021-12-31$2,415
Interest earned on other investments2021-12-31$58,735
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$2,539,608
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$2,600,995
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$1,770,390
Net investment gain/loss from pooled separate accounts2021-12-31$53,816
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
Contributions received in cash from employer2021-12-31$50,411
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$3,014,822
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 plan2021-12-31Disclaimer
Accountancy firm name2021-12-31RSM US LLP
Accountancy firm EIN2021-12-31420714325
2020 : SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2020 401k financial data
Total income from all sources (including contributions)2020-12-31$3,642,304
Total of all expenses incurred2020-12-31$7,417,713
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$7,391,790
Expenses. Certain deemed distributions of participant loans2020-12-31$4,062
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,196,453
Value of total assets at end of year2020-12-31$19,796,941
Value of total assets at beginning of year2020-12-31$23,572,350
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$21,861
Total interest from all sources2020-12-31$65,390
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$237,653
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$237,653
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$710,198
Participant contributions at end of year2020-12-31$49,969
Participant contributions at beginning of year2020-12-31$144,479
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$415,053
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$323
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$278
Administrative expenses (other) incurred2020-12-31$21,861
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-3,775,409
Value of net assets at end of year (total assets less liabilities)2020-12-31$19,796,941
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$23,572,350
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$16,912,177
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$20,749,621
Value of interest in pooled separate accounts at end of year2020-12-31$233,477
Value of interest in pooled separate accounts at beginning of year2020-12-31$207,798
Interest on participant loans2020-12-31$4,861
Interest earned on other investments2020-12-31$60,529
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$2,600,995
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$2,470,174
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$2,109,343
Net investment gain/loss from pooled separate accounts2020-12-31$33,465
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$71,202
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$7,391,790
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31No
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31RSM US LLP
Accountancy firm EIN2020-12-31420714325
2019 : SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2019 401k financial data
Total income from all sources (including contributions)2019-12-31$5,183,189
Total of all expenses incurred2019-12-31$1,626,181
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$1,605,565
Expenses. Certain deemed distributions of participant loans2019-12-31$1,360
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,353,162
Value of total assets at end of year2019-12-31$23,572,350
Value of total assets at beginning of year2019-12-31$20,015,342
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$19,256
Total interest from all sources2019-12-31$64,686
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$318,714
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$318,714
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$1,188,010
Participant contributions at end of year2019-12-31$144,479
Participant contributions at beginning of year2019-12-31$137,111
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$28,146
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$278
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Administrative expenses (other) incurred2019-12-31$19,256
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$3,557,008
Value of net assets at end of year (total assets less liabilities)2019-12-31$23,572,350
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$20,015,342
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$20,749,621
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$17,660,112
Value of interest in pooled separate accounts at end of year2019-12-31$207,798
Value of interest in pooled separate accounts at beginning of year2019-12-31$250,988
Interest on participant loans2019-12-31$8,005
Interest earned on other investments2019-12-31$56,681
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$2,470,174
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$1,967,131
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$3,385,963
Net investment gain/loss from pooled separate accounts2019-12-31$60,664
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$137,006
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$1,605,565
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31RSM US LLP
Accountancy firm EIN2019-12-31420714325
2018 : SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2018 401k financial data
Total income from all sources (including contributions)2018-12-31$646,901
Total of all expenses incurred2018-12-31$2,764,397
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$2,746,443
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$1,489,806
Value of total assets at end of year2018-12-31$20,015,499
Value of total assets at beginning of year2018-12-31$22,132,995
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$17,954
Total interest from all sources2018-12-31$56,185
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$291,552
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$291,552
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$1,237,699
Participant contributions at end of year2018-12-31$137,111
Participant contributions at beginning of year2018-12-31$144,809
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$140,284
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$157
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$146
Administrative expenses (other) incurred2018-12-31$17,954
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-2,117,496
Value of net assets at end of year (total assets less liabilities)2018-12-31$20,015,499
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$22,132,995
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$17,660,112
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$19,795,655
Value of interest in pooled separate accounts at end of year2018-12-31$250,988
Value of interest in pooled separate accounts at beginning of year2018-12-31$395,497
Interest on participant loans2018-12-31$6,782
Interest earned on other investments2018-12-31$49,403
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$1,967,131
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$1,796,888
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-1,173,405
Net investment gain/loss from pooled separate accounts2018-12-31$-17,237
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31Yes
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$111,823
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$2,746,443
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31RSM US LLP
Accountancy firm EIN2018-12-31420714325
2017 : SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2017 401k financial data
Total income from all sources (including contributions)2017-12-31$5,019,455
Total of all expenses incurred2017-12-31$4,026,478
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$3,984,825
Expenses. Certain deemed distributions of participant loans2017-12-31$11,612
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$1,812,154
Value of total assets at end of year2017-12-31$22,132,995
Value of total assets at beginning of year2017-12-31$21,140,018
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$30,041
Total interest from all sources2017-12-31$59,682
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$277,066
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$277,066
Administrative expenses professional fees incurred2017-12-31$13,500
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$1,344,795
Participant contributions at end of year2017-12-31$144,809
Participant contributions at beginning of year2017-12-31$129,875
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$304,969
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$146
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$0
Administrative expenses (other) incurred2017-12-31$16,541
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$992,977
Value of net assets at end of year (total assets less liabilities)2017-12-31$22,132,995
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$21,140,018
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$19,795,655
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$16,369,013
Value of interest in pooled separate accounts at end of year2017-12-31$395,497
Value of interest in pooled separate accounts at beginning of year2017-12-31$645,362
Interest on participant loans2017-12-31$10,881
Interest earned on other investments2017-12-31$48,801
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$323,978
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$323,978
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$1,796,888
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$3,671,790
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$2,785,260
Net investment gain/loss from pooled separate accounts2017-12-31$85,293
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$162,390
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$3,984,825
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31Yes
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31CROWE, LLP
Accountancy firm EIN2017-12-31350921680
2016 : SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$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$3,286,619
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$4,132,187
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$4,121,902
Expenses. Certain deemed distributions of participant loans2016-12-31$7,000
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$1,738,356
Value of total assets at end of year2016-12-31$21,140,018
Value of total assets at beginning of year2016-12-31$21,985,586
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$3,285
Total interest from all sources2016-12-31$108,516
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$1,359,260
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$1,359,260
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$1,454,679
Participant contributions at end of year2016-12-31$129,875
Participant contributions at beginning of year2016-12-31$164,068
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$95,633
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-12-31$11,979
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-845,568
Value of net assets at end of year (total assets less liabilities)2016-12-31$21,140,018
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$21,985,586
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$16,369,013
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$17,327,703
Value of interest in pooled separate accounts at end of year2016-12-31$645,362
Value of interest in pooled separate accounts at beginning of year2016-12-31$758,370
Interest on participant loans2016-12-31$5,364
Interest earned on other investments2016-12-31$102,721
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$323,978
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$413,130
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$413,130
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$431
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$3,671,790
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$3,322,315
Net investment gain/loss from pooled separate accounts2016-12-31$80,487
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$188,044
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$4,109,923
Contract administrator fees2016-12-31$3,285
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31CROWE HORWATH, LLP
Accountancy firm EIN2016-12-31350921680
2015 : SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$1,909,166
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$735,711
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$665,659
Expenses. Certain deemed distributions of participant loans2015-12-31$7,756
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,837,376
Value of total assets at end of year2015-12-31$21,985,586
Value of total assets at beginning of year2015-12-31$20,812,131
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$62,296
Total interest from all sources2015-12-31$56,311
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$-156,681
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$-156,681
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$1,601,280
Participant contributions at end of year2015-12-31$164,068
Participant contributions at beginning of year2015-12-31$232,164
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$35,446
Other income not declared elsewhere2015-12-31$197,457
Administrative expenses (other) incurred2015-12-31$59,211
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$1,173,455
Value of net assets at end of year (total assets less liabilities)2015-12-31$21,985,586
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$20,812,131
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$17,327,703
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$16,393,148
Value of interest in pooled separate accounts at end of year2015-12-31$758,370
Value of interest in pooled separate accounts at beginning of year2015-12-31$774,590
Interest on participant loans2015-12-31$8,400
Interest earned on other investments2015-12-31$47,829
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$413,130
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$296,575
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$296,575
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$82
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$3,322,315
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$3,115,654
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-25,297
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$200,650
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$665,659
Contract administrator fees2015-12-31$3,085
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31CROWE HORWATH, LLP
Accountancy firm EIN2015-12-31350921680
2014 : SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$3,117,724
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$1,301,179
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$1,295,248
Expenses. Certain deemed distributions of participant loans2014-12-31$2,738
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$2,010,314
Value of total assets at end of year2014-12-31$20,812,131
Value of total assets at beginning of year2014-12-31$18,995,586
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$3,193
Total interest from all sources2014-12-31$97,103
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$753,535
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$753,535
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$1,647,895
Participant contributions at end of year2014-12-31$232,164
Participant contributions at beginning of year2014-12-31$246,292
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$151,969
Other income not declared elsewhere2014-12-31$90,008
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$1,816,545
Value of net assets at end of year (total assets less liabilities)2014-12-31$20,812,131
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$18,995,586
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$16,393,148
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$14,709,349
Value of interest in pooled separate accounts at end of year2014-12-31$774,590
Value of interest in pooled separate accounts at beginning of year2014-12-31$745,978
Interest on participant loans2014-12-31$10,124
Interest earned on other investments2014-12-31$86,940
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$296,575
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-12-31$339,137
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-12-31$339,137
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-12-31$39
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$3,115,654
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$2,954,830
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$132,970
Net investment gain/loss from pooled separate accounts2014-12-31$33,794
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$210,450
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$1,295,248
Contract administrator fees2014-12-31$3,193
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31CROWE HORWATH, LLP
Accountancy firm EIN2014-12-31350921680
2013 : SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$4,714,610
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$498,876
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$492,358
Expenses. Certain deemed distributions of participant loans2013-12-31$3,161
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$1,981,637
Value of total assets at end of year2013-12-31$18,995,586
Value of total assets at beginning of year2013-12-31$14,779,852
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$3,357
Total interest from all sources2013-12-31$153,902
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$433,805
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$433,805
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$1,668,841
Participant contributions at end of year2013-12-31$246,292
Participant contributions at beginning of year2013-12-31$186,181
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$86,716
Other income not declared elsewhere2013-12-31$147,388
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$4,215,734
Value of net assets at end of year (total assets less liabilities)2013-12-31$18,995,586
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$14,779,852
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$14,709,349
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$10,434,774
Value of interest in pooled separate accounts at end of year2013-12-31$745,978
Value of interest in pooled separate accounts at beginning of year2013-12-31$645,960
Interest on participant loans2013-12-31$8,720
Interest earned on other investments2013-12-31$145,100
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$339,137
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$293,496
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$293,496
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$82
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$2,954,830
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$2,588,579
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$1,833,742
Net investment gain/loss from pooled separate accounts2013-12-31$164,136
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$226,080
Employer contributions (assets) at beginning of year2013-12-31$630,862
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$492,358
Contract administrator fees2013-12-31$3,357
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31CROWE HORWATH, LLP
Accountancy firm EIN2013-12-31350921680
2012 : SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total income from all sources (including contributions)2012-12-31$4,268,534
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$665,453
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$662,628
Expenses. Certain deemed distributions of participant loans2012-12-31$513
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$2,933,227
Value of total assets at end of year2012-12-31$14,779,852
Value of total assets at beginning of year2012-12-31$11,176,771
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$2,312
Total interest from all sources2012-12-31$87,615
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$298,623
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$298,623
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$1,580,678
Participant contributions at end of year2012-12-31$186,181
Participant contributions at beginning of year2012-12-31$42,933
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$513,622
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$3,603,081
Value of net assets at end of year (total assets less liabilities)2012-12-31$14,779,852
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$11,176,771
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$10,434,774
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$7,868,770
Value of interest in pooled separate accounts at end of year2012-12-31$645,960
Value of interest in pooled separate accounts at beginning of year2012-12-31$669,983
Interest on participant loans2012-12-31$4,361
Interest earned on other investments2012-12-31$83,171
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$293,496
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$314,469
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$314,469
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$83
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$2,588,579
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$1,655,568
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$869,433
Net investment gain/loss from pooled separate accounts2012-12-31$79,636
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$838,927
Employer contributions (assets) at end of year2012-12-31$630,862
Employer contributions (assets) at beginning of year2012-12-31$625,048
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$662,628
Contract administrator fees2012-12-31$2,312
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31CROWE HORWATH, LLP
Accountancy firm EIN2012-12-31350921680
2011 : SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total income from all sources (including contributions)2011-12-31$2,399,354
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$857,730
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$866,829
Expenses. Certain deemed distributions of participant loans2011-12-31$-11,521
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$2,518,096
Value of total assets at end of year2011-12-31$11,176,771
Value of total assets at beginning of year2011-12-31$9,635,147
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$2,422
Total interest from all sources2011-12-31$33,459
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$212,172
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$212,172
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$500,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$1,549,315
Participant contributions at end of year2011-12-31$42,933
Participant contributions at beginning of year2011-12-31$35,669
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$146,598
Administrative expenses (other) incurred2011-12-31$53
Total non interest bearing cash at beginning of year2011-12-31$954
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$1,541,624
Value of net assets at end of year (total assets less liabilities)2011-12-31$11,176,771
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$9,635,147
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$7,868,770
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$5,991,526
Value of interest in pooled separate accounts at end of year2011-12-31$669,983
Value of interest in pooled separate accounts at beginning of year2011-12-31$1,363,789
Interest on participant loans2011-12-31$2,392
Interest earned on other investments2011-12-31$31,018
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$314,469
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$265,800
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$265,800
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$49
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$1,655,568
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$1,649,326
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-357,547
Net investment gain/loss from pooled separate accounts2011-12-31$-6,826
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$822,183
Employer contributions (assets) at end of year2011-12-31$625,048
Employer contributions (assets) at beginning of year2011-12-31$328,083
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$866,829
Contract administrator fees2011-12-31$2,369
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31CROWE HORWATH, LLP
Accountancy firm EIN2011-12-31350921680
2010 : SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$2,606,948
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$443,634
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$397,401
Expenses. Certain deemed distributions of participant loans2010-12-31$15,803
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$1,859,436
Value of total assets at end of year2010-12-31$9,307,063
Value of total assets at beginning of year2010-12-31$7,143,749
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$30,430
Total interest from all sources2010-12-31$89,081
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$128,838
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$128,838
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
If this is an individual account plan, was there a blackout period2010-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$1,728,038
Participant contributions at end of year2010-12-31$35,668
Participant contributions at beginning of year2010-12-31$9,578
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$51,063
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2010-12-31$183,540
Other income not declared elsewhere2010-12-31$37,437
Administrative expenses (other) incurred2010-12-31$140
Total non interest bearing cash at end of year2010-12-31$954
Total non interest bearing cash at beginning of year2010-12-31$27
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$2,163,314
Value of net assets at end of year (total assets less liabilities)2010-12-31$9,307,063
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$7,143,749
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Investment advisory and management fees2010-12-31$29,189
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$5,991,526
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$3,175,451
Value of interest in pooled separate accounts at end of year2010-12-31$1,363,789
Value of interest in pooled separate accounts at beginning of year2010-12-31$1,756,283
Interest on participant loans2010-12-31$979
Interest earned on other investments2010-12-31$88,229
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$265,800
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$217,451
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$217,451
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$-127
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$1,649,326
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$1,984,959
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$339,243
Net investment gain/loss from pooled separate accounts2010-12-31$152,913
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$80,335
Employer contributions (assets) at end of year2010-12-31$328,083
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$213,861
Contract administrator fees2010-12-31$1,101
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31Yes
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31CROWE HORWATH, LLP
Accountancy firm EIN2010-12-31350921680

Form 5500 Responses for SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN

2022: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) 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: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) 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
2020: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: SOUTH BEND MEDICAL FOUNDATION, INC 403(B) RETIREMENT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedYes
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1088360
Policy instance 2
Insurance contract or identification number1088360
Number of Individuals Covered12
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753 001
Policy instance 1
Insurance contract or identification number071753 001
Number of Individuals Covered7
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberTA069850
Policy instance 3
Insurance contract or identification numberTA069850
Number of Individuals Covered230
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
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberTA069850
Policy instance 4
Insurance contract or identification numberTA069850
Number of Individuals Covered254
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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1088360
Policy instance 3
Insurance contract or identification number1088360
Number of Individuals Covered13
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVFZ302
Policy instance 2
Insurance contract or identification numberVFZ302
Number of Individuals Covered3
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753 001
Policy instance 1
Insurance contract or identification number071753 001
Number of Individuals Covered9
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753 001
Policy instance 1
Insurance contract or identification number071753 001
Number of Individuals Covered10
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVFZ302
Policy instance 2
Insurance contract or identification numberVFZ302
Number of Individuals Covered12
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1088360
Policy instance 3
Insurance contract or identification number1088360
Number of Individuals Covered15
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberTA069850
Policy instance 4
Insurance contract or identification numberTA069850
Number of Individuals Covered290
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753 001
Policy instance 1
Insurance contract or identification number071753 001
Number of Individuals Covered8
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVFZ302
Policy instance 2
Insurance contract or identification numberVFZ302
Number of Individuals Covered23
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1088360
Policy instance 3
Insurance contract or identification number1088360
Number of Individuals Covered14
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberTA069850
Policy instance 4
Insurance contract or identification numberTA069850
Number of Individuals Covered525
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753
Policy instance 1
Insurance contract or identification number071753
Number of Individuals Covered2
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753 001
Policy instance 2
Insurance contract or identification number071753 001
Number of Individuals Covered14
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVFZ302
Policy instance 3
Insurance contract or identification numberVFZ302
Number of Individuals Covered32
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1088360
Policy instance 4
Insurance contract or identification number1088360
Number of Individuals Covered16
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberTA069850
Policy instance 5
Insurance contract or identification numberTA069850
Number of Individuals Covered556
Insurance policy start date2018-02-01
Insurance policy end date2018-12-31
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
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberTA069850
Policy instance 5
Insurance contract or identification numberTA069850
Number of Individuals Covered599
Insurance policy start date2017-02-01
Insurance policy end date2017-12-31
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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1088360
Policy instance 4
Insurance contract or identification number1088360
Number of Individuals Covered18
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVFZ302
Policy instance 3
Insurance contract or identification numberVFZ302
Number of Individuals Covered47
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $399
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $399
Insurance broker organization code?3
Insurance broker nameFIRST ALLIED SECURITIES, INC
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753 001
Policy instance 2
Insurance contract or identification number071753 001
Number of Individuals Covered14
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753
Policy instance 1
Insurance contract or identification number071753
Number of Individuals Covered2
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753
Policy instance 1
Insurance contract or identification number071753
Number of Individuals Covered2
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753 001
Policy instance 2
Insurance contract or identification number071753 001
Number of Individuals Covered16
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVFZ302
Policy instance 3
Insurance contract or identification numberVFZ302
Number of Individuals Covered750
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,426
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $4,426
Insurance broker organization code?3
Insurance broker nameFIRST ALLIED SECURITIES, INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1088360
Policy instance 4
Insurance contract or identification number1088360
Number of Individuals Covered19
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVFZ302
Policy instance 2
Insurance contract or identification numberVFZ302
Number of Individuals Covered768
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $3,820
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $3,820
Insurance broker organization code?3
Insurance broker nameFIRST ALLIED SECURITIES, INC
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753
Policy instance 4
Insurance contract or identification number071753
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1088360
Policy instance 3
Insurance contract or identification number1088360
Number of Individuals Covered21
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753 001
Policy instance 1
Insurance contract or identification number071753 001
Number of Individuals Covered18
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753 001
Policy instance 1
Insurance contract or identification number071753 001
Number of Individuals Covered19
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVFZ302
Policy instance 2
Insurance contract or identification numberVFZ302
Number of Individuals Covered767
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,420
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $3,420
Insurance broker organization code?3
Insurance broker nameFIRST ALLIED SECURITIES, INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1088360
Policy instance 3
Insurance contract or identification number1088360
Number of Individuals Covered23
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1088360
Policy instance 3
Insurance contract or identification number1088360
Number of Individuals Covered26
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVFZ302
Policy instance 2
Insurance contract or identification numberVFZ302
Number of Individuals Covered690
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,826
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $3,826
Insurance broker organization code?3
Insurance broker nameFIRST ALLIED SECURITIES, INC
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753 001
Policy instance 1
Insurance contract or identification number071753 001
Number of Individuals Covered22
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1088360
Policy instance 3
Insurance contract or identification number1088360
Number of Individuals Covered28
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVFZ302
Policy instance 2
Insurance contract or identification numberVFZ302
Number of Individuals Covered668
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $11,866
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753 001
Policy instance 1
Insurance contract or identification number071753 001
Number of Individuals Covered23
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1088360
Policy instance 3
Insurance contract or identification number1088360
Number of Individuals Covered32
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $685
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number071753 001
Policy instance 1
Insurance contract or identification number071753 001
Number of Individuals Covered28
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,146
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVFZ302
Policy instance 2
Insurance contract or identification numberVFZ302
Number of Individuals Covered308
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,122
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No

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