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ROCKFORD HEALTH SYSTEM CODE 403(B) PLAN 401k Plan overview

Plan NameROCKFORD HEALTH SYSTEM CODE 403(B) PLAN
Plan identification number 006

ROCKFORD HEALTH SYSTEM CODE 403(B) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • 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.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

MERCY HEALTH CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:MERCY HEALTH CORPORATION
Employer identification number (EIN):472158680
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROCKFORD HEALTH SYSTEM CODE 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0062017-01-01KATHY HARRIS

Plan Statistics for ROCKFORD HEALTH SYSTEM CODE 403(B) PLAN

401k plan membership statisitcs for ROCKFORD HEALTH SYSTEM CODE 403(B) PLAN

Measure Date Value
2017: ROCKFORD HEALTH SYSTEM CODE 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-015,077
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-010
Number of participants with account balances2017-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010

Financial Data on ROCKFORD HEALTH SYSTEM CODE 403(B) PLAN

Measure Date Value
2017 : ROCKFORD HEALTH SYSTEM CODE 403(B) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-01-31$0
Total transfer of assets from this plan2017-01-31$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 assets2017-01-31$0
Total of all expenses incurred2017-01-31$4,300,641
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-01-31$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 year2017-01-31$0
Value of total assets at beginning of year2017-01-31$169,898,993
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-01-31$4,324
Total interest from all sources2017-01-31$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 year2017-01-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2017-01-31$0
Total dividends received from registered investment company shares (eg mutual funds)2017-01-31$25,038
Was this plan covered by a fidelity bond2017-01-31Yes
Value of fidelity bond cover2017-01-31$10,000,000
If this is an individual account plan, was there a blackout period2017-01-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-01-31$0
Were there any nonexempt tranactions with any party-in-interest2017-01-31No
Contributions received from participants2017-01-31$135,142
Participant contributions at end of year2017-01-31$0
Participant contributions at beginning of year2017-01-31$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 appraiser2017-01-31No
Value of net income/loss2017-01-31$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)2017-01-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-01-31No
Were any leases to which the plan was party in default or uncollectible2017-01-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-01-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-01-31$157,615,244
Value of interest in pooled separate accounts at end of year2017-01-31$0
Value of interest in pooled separate accounts at beginning of year2017-01-31$1,758,137
Interest on participant loans2017-01-31$8,880
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-01-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-01-31$4,211,397
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-01-31$4,211,397
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-01-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-01-31$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 assets2017-01-31No
Was there a failure to transmit to the plan any participant contributions2017-01-31No
Has the plan failed to provide any benefit when due under the plan2017-01-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-01-31$4,296,317
Contract administrator fees2017-01-31$4,324
Did the plan have assets held for investment2017-01-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-01-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-01-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-01-31Yes
Opinion of an independent qualified public accountant for this plan2017-01-31Disclaimer
Accountancy firm name2017-01-31WIPFLI LLP
Accountancy firm EIN2017-01-31390758449

Form 5500 Responses for ROCKFORD HEALTH SYSTEM CODE 403(B) PLAN

2017: ROCKFORD HEALTH SYSTEM CODE 403(B) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingYes
2017-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number450830/806623
Policy instance 1
Insurance contract or identification number450830/806623
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 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
Amount paid for insurance broker fees1750
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameFIDELITY INVESTMENTS TAX-EXEMPT SVC
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE0308
Policy instance 2
Insurance contract or identification numberVE0308
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-01-31
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 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
Insurance broker organization code?3
Insurance broker nameKATHI CLINTON MEYER
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )
Policy contract numberK0938
Policy instance 3
Insurance contract or identification numberK0938
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-01-31
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 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?No
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
Insurance broker organization code?3
Insurance broker nameGREG K. MYERS
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberA008017539
Policy instance 4
Insurance contract or identification numberA008017539
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-01-31
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 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?No
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
C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )
Policy contract numberEXT0104239EE
Policy instance 5
Insurance contract or identification numberEXT0104239EE
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-01-31
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 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?No
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
Insurance broker organization code?3
Insurance broker nameTIMOTHY W POWERS
ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )
Policy contract numberK3661
Policy instance 6
Insurance contract or identification numberK3661
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-01-31
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 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?No
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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