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MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 401k Plan overview

Plan NameMAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN
Plan identification number 002

MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC.
Employer identification number (EIN):390813418
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022015-01-01DAVID SCHUITEMA DAVID SCHUITEMA2016-07-13
0022014-01-01DAVID SCHUITEMA DAVID SCHUITEMA2015-10-07
0022013-01-01LESLIE SMITH LESLIE SMITH2014-10-14
0022012-01-01LESLIE SMITH LESLIE SMITH2013-10-08
0022011-01-01LESLIE SMITH
0022010-01-01LESLIE SMITH
0022009-01-01LESLIE SMITH

Plan Statistics for MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN

Measure Date Value
2015: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,750
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-010
Number of participants with account balances2015-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-0110
2014: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,680
Total number of active participants reported on line 7a of the Form 55002014-01-011,450
Number of retired or separated participants receiving benefits2014-01-0119
Number of other retired or separated participants entitled to future benefits2014-01-01278
Total of all active and inactive participants2014-01-011,747
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-013
Total participants2014-01-011,750
Number of participants with account balances2014-01-011,595
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-0126
2013: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,644
Total number of active participants reported on line 7a of the Form 55002013-01-011,440
Number of retired or separated participants receiving benefits2013-01-0117
Number of other retired or separated participants entitled to future benefits2013-01-01219
Total of all active and inactive participants2013-01-011,676
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-014
Total participants2013-01-011,680
Number of participants with account balances2013-01-011,510
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-0117
2012: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,526
Total number of active participants reported on line 7a of the Form 55002012-01-011,398
Number of retired or separated participants receiving benefits2012-01-0118
Number of other retired or separated participants entitled to future benefits2012-01-01224
Total of all active and inactive participants2012-01-011,640
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-014
Total participants2012-01-011,644
Number of participants with account balances2012-01-011,496
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-0155
2011: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,428
Total number of active participants reported on line 7a of the Form 55002011-01-011,320
Number of retired or separated participants receiving benefits2011-01-0116
Number of other retired or separated participants entitled to future benefits2011-01-01190
Total of all active and inactive participants2011-01-011,526
Total participants2011-01-011,526
Number of participants with account balances2011-01-011,371
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-0146
2010: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-011,306
Total number of active participants reported on line 7a of the Form 55002010-01-011,259
Number of retired or separated participants receiving benefits2010-01-0111
Number of other retired or separated participants entitled to future benefits2010-01-01158
Total of all active and inactive participants2010-01-011,428
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-011,428
Number of participants with account balances2010-01-011,274
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-0144
2009: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01991
Total number of active participants reported on line 7a of the Form 55002009-01-011,186
Number of retired or separated participants receiving benefits2009-01-019
Number of other retired or separated participants entitled to future benefits2009-01-01111
Total of all active and inactive participants2009-01-011,306
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-011,306
Number of participants with account balances2009-01-011,120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-0122

Financial Data on MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN

Measure Date Value
2015 : MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-09-30$-44,706
Total unrealized appreciation/depreciation of assets2015-09-30$-44,706
Total transfer of assets from this plan2015-09-30$63,928,486
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$123,481
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$0
Total income from all sources (including contributions)2015-09-30$-2,391,578
Total loss/gain on sale of assets2015-09-30$0
Total of all expenses incurred2015-09-30$4,358,648
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-09-30$4,276,628
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-09-30$0
Value of total assets at end of year2015-09-30$123,481
Value of total assets at beginning of year2015-09-30$70,678,712
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-09-30$82,020
Total interest from all sources2015-09-30$45,569
Total dividends received (eg from common stock, registered investment company shares)2015-09-30$822,967
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2015-09-30$822,967
Was this plan covered by a fidelity bond2015-09-30Yes
Value of fidelity bond cover2015-09-30$5,000,000
If this is an individual account plan, was there a blackout period2015-09-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-09-30$0
Were there any nonexempt tranactions with any party-in-interest2015-09-30No
Participant contributions at end of year2015-09-30$0
Participant contributions at beginning of year2015-09-30$1,582,297
Assets. Other investments not covered elsewhere at end of year2015-09-30$123,481
Assets. Other investments not covered elsewhere at beginning of year2015-09-30$783,583
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-09-30$123,481
Other income not declared elsewhere2015-09-30$40,815
Administrative expenses (other) incurred2015-09-30$82,020
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Value of net income/loss2015-09-30$-6,750,226
Value of net assets at end of year (total assets less liabilities)2015-09-30$0
Value of net assets at beginning of year (total assets less liabilities)2015-09-30$70,678,712
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-09-30No
Were any leases to which the plan was party in default or uncollectible2015-09-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-09-30$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-09-30$61,881,566
Income. Interest from loans (other than to participants)2015-09-30$45,569
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-09-30$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-09-30$1,173,999
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-09-30$1,173,999
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-09-30$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-09-30$1,718,731
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-09-30$-3,256,223
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-09-30No
Was there a failure to transmit to the plan any participant contributions2015-09-30No
Has the plan failed to provide any benefit when due under the plan2015-09-30No
Employer contributions (assets) at end of year2015-09-30$0
Employer contributions (assets) at beginning of year2015-09-30$3,538,536
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-09-30$4,276,628
Did the plan have assets held for investment2015-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-09-30Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-09-30Yes
Opinion of an independent qualified public accountant for this plan2015-09-30Disclaimer
Accountancy firm name2015-09-30RSM US LLP
Accountancy firm EIN2015-09-30420714325
2014 : MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$-12,906
Total unrealized appreciation/depreciation of assets2014-12-31$-12,906
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$11,110,596
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$3,534,703
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$3,433,231
Expenses. Certain deemed distributions of participant loans2014-12-31$2,787
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$7,423,203
Value of total assets at end of year2014-12-31$70,678,712
Value of total assets at beginning of year2014-12-31$63,102,819
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$98,685
Total interest from all sources2014-12-31$62,864
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$2,811,077
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$2,811,077
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$5,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$3,455,803
Participant contributions at end of year2014-12-31$1,582,297
Participant contributions at beginning of year2014-12-31$1,432,488
Assets. Other investments not covered elsewhere at end of year2014-12-31$783,583
Assets. Other investments not covered elsewhere at beginning of year2014-12-31$487,173
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$427,974
Other income not declared elsewhere2014-12-31$54,845
Administrative expenses (other) incurred2014-12-31$98,685
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$7,575,893
Value of net assets at end of year (total assets less liabilities)2014-12-31$70,678,712
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$63,102,819
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$61,881,566
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$54,799,536
Interest on participant loans2014-12-31$62,864
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$1,173,999
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-12-31$1,344,870
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-12-31$1,344,870
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$1,718,731
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$1,401,160
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$771,513
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$3,539,426
Employer contributions (assets) at end of year2014-12-31$3,538,536
Employer contributions (assets) at beginning of year2014-12-31$3,637,592
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$3,433,231
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 name2014-12-31MCGLADREY LLP
Accountancy firm EIN2014-12-31420714325
2013 : MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$976
Total unrealized appreciation/depreciation of assets2013-12-31$976
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$16,602,855
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$3,438,346
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$3,357,620
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$7,227,708
Value of total assets at end of year2013-12-31$63,102,819
Value of total assets at beginning of year2013-12-31$49,938,310
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$80,726
Total interest from all sources2013-12-31$61,215
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$1,685,298
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$1,685,298
Administrative expenses professional fees incurred2013-12-31$80,726
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$5,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$3,319,040
Participant contributions at end of year2013-12-31$1,432,488
Participant contributions at beginning of year2013-12-31$1,301,885
Assets. Other investments not covered elsewhere at end of year2013-12-31$487,173
Assets. Other investments not covered elsewhere at beginning of year2013-12-31$364,899
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$270,674
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$13,164,509
Value of net assets at end of year (total assets less liabilities)2013-12-31$63,102,819
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$49,938,310
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$54,799,536
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$42,376,413
Interest on participant loans2013-12-31$61,215
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$1,344,870
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$1,283,486
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$1,283,486
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$1,401,160
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$1,220,641
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$7,538,785
Net investment gain/loss from pooled separate accounts2013-12-31$44,281
Net investment gain or loss from common/collective trusts2013-12-31$44,592
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$3,637,994
Employer contributions (assets) at end of year2013-12-31$3,637,592
Employer contributions (assets) at beginning of year2013-12-31$3,390,986
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$3,357,620
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
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 name2013-12-31MCGLADREY LLP
Accountancy firm EIN2013-12-31420714325
2012 : MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-12-31$8,328
Total unrealized appreciation/depreciation of assets2012-12-31$8,328
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$15,482
Total income from all sources (including contributions)2012-12-31$11,717,876
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$2,305,113
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$2,244,204
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$6,578,397
Value of total assets at end of year2012-12-31$49,938,310
Value of total assets at beginning of year2012-12-31$40,541,029
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$60,909
Total interest from all sources2012-12-31$51,600
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$1,393,285
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$1,393,285
Administrative expenses professional fees incurred2012-12-31$60,909
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$5,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$3,076,336
Participant contributions at end of year2012-12-31$1,301,885
Participant contributions at beginning of year2012-12-31$998,268
Assets. Other investments not covered elsewhere at end of year2012-12-31$364,899
Assets. Other investments not covered elsewhere at beginning of year2012-12-31$269,227
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$111,075
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$15,482
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$9,412,763
Value of net assets at end of year (total assets less liabilities)2012-12-31$49,938,310
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$40,525,547
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$42,376,413
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$33,823,570
Interest on participant loans2012-12-31$51,600
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$1,283,486
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$952,094
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$952,094
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$1,220,641
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$1,189,046
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$3,665,343
Net investment gain/loss from pooled separate accounts2012-12-31$-18,738
Net investment gain or loss from common/collective trusts2012-12-31$39,661
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$3,390,986
Employer contributions (assets) at end of year2012-12-31$3,390,986
Employer contributions (assets) at beginning of year2012-12-31$3,308,824
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$2,244,204
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
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 name2012-12-31MCGLADREY LLP
Accountancy firm EIN2012-12-31420714325
2011 : MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$8,328
Total unrealized appreciation/depreciation of assets2011-12-31$8,328
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$15,482
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$32,839
Total income from all sources (including contributions)2011-12-31$5,971,621
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$1,398,401
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$1,342,732
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$6,295,358
Value of total assets at end of year2011-12-31$40,541,029
Value of total assets at beginning of year2011-12-31$35,985,166
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$55,669
Total interest from all sources2011-12-31$39,281
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$1,048,897
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$1,048,897
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$5,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$2,818,763
Participant contributions at end of year2011-12-31$998,268
Participant contributions at beginning of year2011-12-31$664,302
Assets. Other investments not covered elsewhere at end of year2011-12-31$269,227
Assets. Other investments not covered elsewhere at beginning of year2011-12-31$109,115
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$167,771
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$15,482
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$32,839
Other income not declared elsewhere2011-12-31$-3,100
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$4,573,220
Value of net assets at end of year (total assets less liabilities)2011-12-31$40,525,547
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$35,952,327
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$33,823,570
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$29,998,589
Interest on participant loans2011-12-31$39,239
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$952,094
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$671,902
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$671,902
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$42
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$1,189,046
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$1,180,575
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-1,459,950
Net investment gain or loss from common/collective trusts2011-12-31$42,807
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$3,308,824
Employer contributions (assets) at end of year2011-12-31$3,308,824
Employer contributions (assets) at beginning of year2011-12-31$3,360,683
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$1,342,732
Contract administrator fees2011-12-31$55,669
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
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 name2011-12-31MCGLADREY LLP
Accountancy firm EIN2011-12-31420714325
2010 : MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2010-12-31$2,642
Total unrealized appreciation/depreciation of assets2010-12-31$2,642
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$32,839
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$9,887,936
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$1,342,606
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$1,301,530
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$6,518,334
Value of total assets at end of year2010-12-31$35,985,166
Value of total assets at beginning of year2010-12-31$27,406,997
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$41,076
Total interest from all sources2010-12-31$31,087
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$693,589
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$693,589
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$5,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$2,622,911
Participant contributions at end of year2010-12-31$664,302
Participant contributions at beginning of year2010-12-31$460,975
Assets. Other investments not covered elsewhere at end of year2010-12-31$109,115
Assets. Other investments not covered elsewhere at beginning of year2010-12-31$13,876
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$532,063
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$32,839
Other income not declared elsewhere2010-12-31$1,437
Administrative expenses (other) incurred2010-12-31$41,076
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$8,545,330
Value of net assets at end of year (total assets less liabilities)2010-12-31$35,952,327
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$27,406,997
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$29,998,589
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$22,473,702
Interest on participant loans2010-12-31$30,940
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$671,902
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$147
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$1,180,575
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$1,190,561
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$2,602,219
Net investment gain or loss from common/collective trusts2010-12-31$38,628
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$3,363,360
Employer contributions (assets) at end of year2010-12-31$3,360,683
Employer contributions (assets) at beginning of year2010-12-31$3,267,883
Income. Dividends from preferred stock2010-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$1,301,530
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
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 name2010-12-31MCGLADREY & PULLEN, LLP
Accountancy firm EIN2010-12-31420714325
2009 : MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN

2015: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS 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 filingYes
2015-01-01This return/report is a short plan year return/report (less than 12 months)Yes
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: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS 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: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS 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: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS 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: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS 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: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS 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
2009: MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL AFFILIATES RETIREMENT SAVINGS PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number150151
Policy instance 2
Insurance contract or identification number150151
Number of Individuals Covered0
Insurance policy start date2015-01-01
Insurance policy end date2015-09-30
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract numberHK60
Policy instance 1
Insurance contract or identification numberHK60
Number of Individuals Covered0
Insurance policy start date2015-01-01
Insurance policy end date2015-09-30
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number150151
Policy instance 2
Insurance contract or identification number150151
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract numberHK60
Policy instance 1
Insurance contract or identification numberHK60
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number150151
Policy instance 1
Insurance contract or identification number150151
Number of Individuals Covered1
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract numberHK60
Policy instance 2
Insurance contract or identification numberHK60
Number of Individuals Covered1
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number150151
Policy instance 2
Insurance contract or identification number150151
Number of Individuals Covered1
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
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract numberHK60
Policy instance 1
Insurance contract or identification numberHK60
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract numberHK60
Policy instance 1
Insurance contract or identification numberHK60
Number of Individuals Covered1
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract numberHK60
Policy instance 1
Insurance contract or identification numberHK60
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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