401k Plan data: PAVILION SURGERY CENTER 401(K) PLAN plan

PAVILION SURGERY CENTER 401(K) PLAN 401k Plan overview

Plan Name	PAVILION SURGERY CENTER 401(K) PLAN
Plan identification number	001

PAVILION SURGERY CENTER 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

ST. LUKE'S HOSPITAL OF DULUTH has sponsored the creation of one or more 401k plans.

Company Name: ST. LUKE'S HOSPITAL OF DULUTH

Employer identification number (EIN): 411979428

NAIC Classification: 621493
NAIC Description: Freestanding Ambulatory Surgical and Emergency Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PAVILION SURGERY CENTER 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01 ESTHER LINDEMAN 2020-01-30 ESTHER LINDEMAN 2020-01-30
001 2018-01-01 ESTHER LINDEMAN 2019-05-30 ESTHER LINDEMAN 2019-05-30
001 2017-01-01 ESTHER LINDEMAN 2018-06-06 ESTHER LINDEMAN 2018-06-06
001 2016-01-01 ESTHER LINDEMAN 2017-01-30 ESTHER LINDEMAN 2017-01-30
001 2015-01-01 ESTHER LINDEMAN 2016-06-22 ESTHER LINDEMAN 2016-06-22
001 2014-01-01 ESTHER LINDEMAN 2015-09-21 ESTHER LINDEMAN 2015-09-21
001 2013-01-01 ESTHER LINDEMAN 2014-07-10 ESTHER LINDEMAN 2014-07-10
001 2012-01-01 ESTHER LINDEMAN 2013-07-31 ESTHER LINDEMAN 2013-07-31
001 2011-01-01 JAMES MUSTONEN 2012-07-30 JAMES MUSTONEN 2012-07-30
001 2010-01-01 JAMES MUSTONEN 2011-05-26 JAMES MUSTONEN 2011-05-26

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01	ESTHER LINDEMAN	2020-01-30	ESTHER LINDEMAN	2020-01-30
001	2018-01-01	ESTHER LINDEMAN	2019-05-30	ESTHER LINDEMAN	2019-05-30
001	2017-01-01	ESTHER LINDEMAN	2018-06-06	ESTHER LINDEMAN	2018-06-06
001	2016-01-01	ESTHER LINDEMAN	2017-01-30	ESTHER LINDEMAN	2017-01-30
001	2015-01-01	ESTHER LINDEMAN	2016-06-22	ESTHER LINDEMAN	2016-06-22
001	2014-01-01	ESTHER LINDEMAN	2015-09-21	ESTHER LINDEMAN	2015-09-21
001	2013-01-01	ESTHER LINDEMAN	2014-07-10	ESTHER LINDEMAN	2014-07-10
001	2012-01-01	ESTHER LINDEMAN	2013-07-31	ESTHER LINDEMAN	2013-07-31
001	2011-01-01	JAMES MUSTONEN	2012-07-30	JAMES MUSTONEN	2012-07-30
001	2010-01-01	JAMES MUSTONEN	2011-05-26	JAMES MUSTONEN	2011-05-26

Plan Statistics for PAVILION SURGERY CENTER 401(K) PLAN

401k plan membership statisitcs for PAVILION SURGERY CENTER 401(K) PLAN

Measure Date Value
2022: PAVILION SURGERY CENTER 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 40
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 0
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 0
Number of participants with account balances 2022-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 3
2021: PAVILION SURGERY CENTER 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 40
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 32
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 8
Total of all active and inactive participants 2021-01-01 40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 40
Number of participants with account balances 2021-01-01 32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 1
2020: PAVILION SURGERY CENTER 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 34
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 34
Number of other retired or separated participants entitled to future benefits 2020-01-01 6
Total of all active and inactive participants 2020-01-01 40
Total participants 2020-01-01 40
Number of participants with account balances 2020-01-01 30

Measure	Date	Value
2022: PAVILION SURGERY CENTER 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	40
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	0
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	0
Number of participants with account balances	2022-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	3
2021: PAVILION SURGERY CENTER 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	40
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	32
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	8
Total of all active and inactive participants	2021-01-01	40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	40
Number of participants with account balances	2021-01-01	32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	1
2020: PAVILION SURGERY CENTER 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	34
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	34
Number of other retired or separated participants entitled to future benefits	2020-01-01	6
Total of all active and inactive participants	2020-01-01	40
Total participants	2020-01-01	40
Number of participants with account balances	2020-01-01	30

Financial Data on PAVILION SURGERY CENTER 401(K) PLAN

Measure	Date	Value
2022 : PAVILION SURGERY CENTER 401(K) PLAN 2022 401k financial data
Transfers to/from the plan	2022-10-03	$-2,706,663
Total plan liabilities at end of year	2022-10-03	$0
Total plan liabilities at beginning of year	2022-10-03	$0
Total income from all sources	2022-10-03	$-386,316
Expenses. Total of all expenses incurred	2022-10-03	$32,146
Benefits paid (including direct rollovers)	2022-10-03	$30,250
Total plan assets at end of year	2022-10-03	$0
Total plan assets at beginning of year	2022-10-03	$3,125,125
Value of fidelity bond covering the plan	2022-10-03	$400,000
Total contributions received or receivable from participants	2022-10-03	$59,060
Expenses. Other expenses not covered elsewhere	2022-10-03	$0
Contributions received from other sources (not participants or employers)	2022-10-03	$0
Other income received	2022-10-03	$-457,069
Noncash contributions received	2022-10-03	$0
Net income (gross income less expenses)	2022-10-03	$-418,462
Net plan assets at end of year (total assets less liabilities)	2022-10-03	$0
Net plan assets at beginning of year (total assets less liabilities)	2022-10-03	$3,125,125
Assets. Value of participant loans	2022-10-03	$0
Total contributions received or receivable from employer(s)	2022-10-03	$11,693
Value of certain deemed distributions of participant loans	2022-10-03	$0
Value of corrective distributions	2022-10-03	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2022-10-03	$1,896
2021 : PAVILION SURGERY CENTER 401(K) PLAN 2021 401k financial data
Transfers to/from the plan	2021-12-31	$0
Total plan liabilities at end of year	2021-12-31	$0
Total plan liabilities at beginning of year	2021-12-31	$0
Total income from all sources	2021-12-31	$554,673
Expenses. Total of all expenses incurred	2021-12-31	$530,713
Benefits paid (including direct rollovers)	2021-12-31	$528,390
Total plan assets at end of year	2021-12-31	$3,125,125
Total plan assets at beginning of year	2021-12-31	$3,101,165
Value of fidelity bond covering the plan	2021-12-31	$400,000
Total contributions received or receivable from participants	2021-12-31	$118,021
Expenses. Other expenses not covered elsewhere	2021-12-31	$0
Contributions received from other sources (not participants or employers)	2021-12-31	$0
Other income received	2021-12-31	$398,321
Noncash contributions received	2021-12-31	$0
Net income (gross income less expenses)	2021-12-31	$23,960
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$3,125,125
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$3,101,165
Assets. Value of participant loans	2021-12-31	$46,150
Total contributions received or receivable from employer(s)	2021-12-31	$38,331
Value of certain deemed distributions of participant loans	2021-12-31	$0
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$2,323
2020 : PAVILION SURGERY CENTER 401(K) PLAN 2020 401k financial data
Transfers to/from the plan	2020-12-31	$0
Total plan liabilities at end of year	2020-12-31	$0
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$536,599
Expenses. Total of all expenses incurred	2020-12-31	$785,854
Benefits paid (including direct rollovers)	2020-12-31	$785,243
Total plan assets at end of year	2020-12-31	$3,101,165
Total plan assets at beginning of year	2020-12-31	$3,350,420
Value of fidelity bond covering the plan	2020-12-31	$400,000
Total contributions received or receivable from participants	2020-12-31	$153,180
Expenses. Other expenses not covered elsewhere	2020-12-31	$0
Contributions received from other sources (not participants or employers)	2020-12-31	$0
Other income received	2020-12-31	$339,258
Noncash contributions received	2020-12-31	$0
Net income (gross income less expenses)	2020-12-31	$-249,255
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$3,101,165
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$3,350,420
Assets. Value of participant loans	2020-12-31	$49,224
Total contributions received or receivable from employer(s)	2020-12-31	$44,161
Value of certain deemed distributions of participant loans	2020-12-31	$0
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$611

Form 5500 Responses for PAVILION SURGERY CENTER 401(K) PLAN

2022: PAVILION SURGERY CENTER 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	Yes
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: PAVILION SURGERY CENTER 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	This submission is the final filing	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: PAVILION SURGERY CENTER 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	ST. LUKE'S HOSPITAL OF DULUTH
Employer identification number (EIN):	411979428
NAIC Classification:	621493
NAIC Description:	Freestanding Ambulatory Surgical and Emergency Centers