MERCY HEALTH CORPORATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ROCKFORD HEALTH SYSTEM CODE 403(B) PLAN
| Measure | Date | Value |
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| 2017 : ROCKFORD HEALTH SYSTEM CODE 403(B) PLAN 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-01-31 | $0 |
| Total transfer of assets from this plan | 2017-01-31 | $169,906,132 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-01-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-01-31 | $0 |
| Total income from all sources (including contributions) | 2017-01-31 | $4,307,780 |
| Total loss/gain on sale of assets | 2017-01-31 | $0 |
| Total of all expenses incurred | 2017-01-31 | $4,300,641 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-01-31 | $4,296,317 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-01-31 | $135,142 |
| Value of total assets at end of year | 2017-01-31 | $0 |
| Value of total assets at beginning of year | 2017-01-31 | $169,898,993 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-01-31 | $4,324 |
| Total interest from all sources | 2017-01-31 | $8,880 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-01-31 | $25,038 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-01-31 | Yes |
| Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan | 2017-01-31 | $0 |
| Total dividends received from registered investment company shares (eg mutual funds) | 2017-01-31 | $25,038 |
| Was this plan covered by a fidelity bond | 2017-01-31 | Yes |
| Value of fidelity bond cover | 2017-01-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2017-01-31 | No |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2017-01-31 | $0 |
| Were there any nonexempt tranactions with any party-in-interest | 2017-01-31 | No |
| Contributions received from participants | 2017-01-31 | $135,142 |
| Participant contributions at end of year | 2017-01-31 | $0 |
| Participant contributions at beginning of year | 2017-01-31 | $2,603,712 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-01-31 | No |
| Value of net income/loss | 2017-01-31 | $7,139 |
| Value of net assets at end of year (total assets less liabilities) | 2017-01-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-01-31 | $169,898,993 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-01-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2017-01-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2017-01-31 | $157,615,244 |
| Value of interest in pooled separate accounts at end of year | 2017-01-31 | $0 |
| Value of interest in pooled separate accounts at beginning of year | 2017-01-31 | $1,758,137 |
| Interest on participant loans | 2017-01-31 | $8,880 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-01-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-01-31 | $4,211,397 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-01-31 | $4,211,397 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2017-01-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2017-01-31 | $3,710,503 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2017-01-31 | $4,138,720 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-01-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-01-31 | $4,296,317 |
| Contract administrator fees | 2017-01-31 | $4,324 |
| Did the plan have assets held for investment | 2017-01-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-01-31 | Yes |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-01-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2017-01-31 | Disclaimer |
| Accountancy firm name | 2017-01-31 | WIPFLI LLP |
| Accountancy firm EIN | 2017-01-31 | 390758449 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 450830/806623 |
| Policy instance | 1 |
| Insurance contract or identification number | 450830/806623 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,750 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1750 | | Additional information about fees paid to insurance broker | REFERRAL/SERVICE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | FIDELITY INVESTMENTS TAX-EXEMPT SVC |
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| VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 ) |
| Policy contract number | VE0308 |
| Policy instance | 2 |
| Insurance contract or identification number | VE0308 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-01-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | KATHI CLINTON MEYER |
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| ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 ) |
| Policy contract number | K0938 |
| Policy instance | 3 |
| Insurance contract or identification number | K0938 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-01-31 | | Are there contracts with allocated funds for individual policies? | 1 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | GREG K. MYERS |
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| MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
| Policy contract number | A008017539 |
| Policy instance | 4 |
| Insurance contract or identification number | A008017539 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-01-31 | | Are there contracts with allocated funds for individual policies? | 1 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 ) |
| Policy contract number | EXT0104239EE |
| Policy instance | 5 |
| Insurance contract or identification number | EXT0104239EE | | Number of Individuals Covered | 0 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-01-31 | | Are there contracts with allocated funds for individual policies? | 1 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | TIMOTHY W POWERS |
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| ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 ) |
| Policy contract number | K3661 |
| Policy instance | 6 |
| Insurance contract or identification number | K3661 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-01-31 | | Are there contracts with allocated funds for individual policies? | 1 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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