401k Plan data: PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN plan

PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 401k Plan overview

Plan Name	PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN
Plan identification number	001

PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

PREMIUM HEALTH SYSTEMS, INC. has sponsored the creation of one or more 401k plans.

Company Name: PREMIUM HEALTH SYSTEMS, INC.

Employer identification number (EIN): 463545152

NAIC Classification: 812990
NAIC Description: All Other Personal Services

Additional information about PREMIUM HEALTH SYSTEMS, INC.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 2000-01-05

Company Identification Number: 602003246

Legal Registered Office Address: 958 INDUSTRY DR

TUKWILA
United States of America (USA)
98188

More information about PREMIUM HEALTH SYSTEMS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 STANLEY GUILBAUD
001 2015-01-01 STANLEY GUILBAUD
001 2014-01-01 STANLEY GUILBAUD
001 2013-08-29 STANLEY GUILBAUD

Plan id#	Filing Submission Date	Name of Administrator
001	2016-01-01	STANLEY GUILBAUD
001	2015-01-01	STANLEY GUILBAUD
001	2014-01-01	STANLEY GUILBAUD
001	2013-08-29	STANLEY GUILBAUD

Plan Statistics for PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN

401k plan membership statisitcs for PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN

Measure Date Value
2016: PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 2
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 2
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 2
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 2
Number of participants with account balances 2015-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 2
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 2
Number of participants with account balances 2014-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-08-29 2
Total number of active participants reported on line 7a of the Form 5500 2013-08-29 2
Number of retired or separated participants receiving benefits 2013-08-29 0
Number of other retired or separated participants entitled to future benefits 2013-08-29 0
Total of all active and inactive participants 2013-08-29 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-08-29 0
Total participants 2013-08-29 2
Number of participants with account balances 2013-08-29 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-08-29 0

Measure	Date	Value
2016: PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	2
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	2
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	2
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	2
Number of participants with account balances	2015-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	2
Number of participants with account balances	2014-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-08-29	2
Total number of active participants reported on line 7a of the Form 5500	2013-08-29	2
Number of retired or separated participants receiving benefits	2013-08-29	0
Number of other retired or separated participants entitled to future benefits	2013-08-29	0
Total of all active and inactive participants	2013-08-29	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-08-29	0
Total participants	2013-08-29	2
Number of participants with account balances	2013-08-29	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-08-29	0

Financial Data on PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN

Measure	Date	Value
2016 : PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$-5,000
Expenses. Total of all expenses incurred	2016-12-31	$0
Benefits paid (including direct rollovers)	2016-12-31	$0
Total plan assets at end of year	2016-12-31	$0
Total plan assets at beginning of year	2016-12-31	$5,000
Total contributions received or receivable from participants	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$-5,000
Net income (gross income less expenses)	2016-12-31	$-5,000
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$5,000
Assets. Value of employer securities	2016-12-31	$0
Total contributions received or receivable from employer(s)	2016-12-31	$0
Value of certain deemed distributions of participant loans	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$0
2015 : PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$-30,000
Expenses. Total of all expenses incurred	2015-12-31	$0
Benefits paid (including direct rollovers)	2015-12-31	$0
Total plan assets at end of year	2015-12-31	$5,000
Total plan assets at beginning of year	2015-12-31	$35,000
Total contributions received or receivable from participants	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-30,000
Net income (gross income less expenses)	2015-12-31	$-30,000
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$5,000
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$35,000
Assets. Value of employer securities	2015-12-31	$5,000
Total contributions received or receivable from employer(s)	2015-12-31	$0
Value of certain deemed distributions of participant loans	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$0
2014 : PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$-76,457
Expenses. Total of all expenses incurred	2014-12-31	$0
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$35,000
Total plan assets at beginning of year	2014-12-31	$111,457
Total contributions received or receivable from participants	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$-76,457
Net income (gross income less expenses)	2014-12-31	$-76,457
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$35,000
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$111,457
Assets. Value of employer securities	2014-12-31	$35,000
Total contributions received or receivable from employer(s)	2014-12-31	$0
Value of certain deemed distributions of participant loans	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$0
2013 : PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$111,472
Expenses. Total of all expenses incurred	2013-12-31	$15
Benefits paid (including direct rollovers)	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$111,457
Total contributions received or receivable from participants	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$152,821
Other income received	2013-12-31	$-41,349
Net income (gross income less expenses)	2013-12-31	$111,457
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$111,457
Assets. Value of employer securities	2013-12-31	$111,457
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$15

Form 5500 Responses for PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN

2016: PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: PREMIUM HEALTH SYSTEMS, INC. RETIREMENT PLAN 2013 form 5500 responses
2013-08-29	Type of plan entity	Single employer plan
2013-08-29	First time form 5500 has been submitted	Yes
2013-08-29	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-08-29	Plan funding arrangement – Trust	Yes
2013-08-29	Plan benefit arrangement - Trust	Yes

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Company Name:	PREMIUM HEALTH SYSTEMS, INC.
Employer identification number (EIN):	463545152
NAIC Classification:	812990
NAIC Description:	All Other Personal Services

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	2000-01-05
Company Identification Number:	602003246
Legal Registered Office Address:	958 INDUSTRY DR TUKWILA United States of America (USA) 98188