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PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 401k Plan overview

Plan NamePELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN
Plan identification number 002

PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • Plan not intended to be qualified - A plan not intended to be qualified under Code sections 401, 403, or 408.

401k Sponsoring company profile

PELEGRINA MEDICAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:PELEGRINA MEDICAL, INC.
Employer identification number (EIN):660382111
NAIC Classification:621399
NAIC Description:Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022022-01-01
0022021-01-01
0022020-01-01
0022019-01-01
0022018-01-01
0022017-01-01JORGE PELEGRINA
0022017-01-01JORGE PELEGRINA
0022016-01-01JORGE PELEGRINA
0022015-01-01JORGE PELEGRINA
0022014-01-01JORGE PELEGRINA
0022013-01-01JORGE PELEGRINA
0022012-01-01JORGE PELEGRINA
0022011-01-01JORGE PELEGRINA
0022009-01-01JORGE PELEGRINA

Plan Statistics for PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN

401k plan membership statisitcs for PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN

Measure Date Value
2022: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-012
Total number of active participants reported on line 7a of the Form 55002022-01-012
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-012
Number of participants with account balances2022-01-012
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-012
Total number of active participants reported on line 7a of the Form 55002021-01-012
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-012
Number of participants with account balances2021-01-012
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-012
Total number of active participants reported on line 7a of the Form 55002020-01-012
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-012
Number of participants with account balances2020-01-012
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-012
Total number of active participants reported on line 7a of the Form 55002019-01-012
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-012
Number of participants with account balances2019-01-012
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-012
Total number of active participants reported on line 7a of the Form 55002018-01-012
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-012
Number of participants with account balances2018-01-012
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-012
Total number of active participants reported on line 7a of the Form 55002017-01-012
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 participants2017-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-012
Number of participants with account balances2017-01-012
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-012
Total number of active participants reported on line 7a of the Form 55002016-01-012
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-012
Number of participants with account balances2016-01-012
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-012
Total number of active participants reported on line 7a of the Form 55002015-01-012
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 participants2015-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-012
Number of participants with account balances2015-01-012
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-012
Total number of active participants reported on line 7a of the Form 55002014-01-012
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-012
Number of participants with account balances2014-01-012
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-013
Total number of active participants reported on line 7a of the Form 55002013-01-012
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-012
Number of participants with account balances2013-01-012
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-013
Total number of active participants reported on line 7a of the Form 55002012-01-012
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-012
Number of participants with account balances2012-01-013
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-014
Total number of active participants reported on line 7a of the Form 55002011-01-010
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-010
Number of participants with account balances2011-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-014
Total number of active participants reported on line 7a of the Form 55002009-01-014
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-014
Number of participants with account balances2009-01-013
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN

Measure Date Value
2022 : PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2022 401k financial data
Total plan liabilities at beginning of year2022-12-31$0
Total income from all sources2022-12-31$-62,408
Expenses. Total of all expenses incurred2022-12-31$30,000
Benefits paid (including direct rollovers)2022-12-31$30,000
Total plan assets at end of year2022-12-31$480,354
Total plan assets at beginning of year2022-12-31$572,762
Total contributions received or receivable from participants2022-12-31$294
Other income received2022-12-31$-62,702
Net income (gross income less expenses)2022-12-31$-92,408
Net plan assets at end of year (total assets less liabilities)2022-12-31$480,354
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$572,762
2021 : PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2021 401k financial data
Transfers to/from the plan2021-12-31$0
Total plan liabilities at end of year2021-12-31$0
Total plan liabilities at beginning of year2021-12-31$0
Total income from all sources2021-12-31$61,048
Expenses. Total of all expenses incurred2021-12-31$89,505
Benefits paid (including direct rollovers)2021-12-31$89,505
Total plan assets at end of year2021-12-31$572,762
Total plan assets at beginning of year2021-12-31$601,219
Total contributions received or receivable from participants2021-12-31$3,345
Expenses. Other expenses not covered elsewhere2021-12-31$0
Contributions received from other sources (not participants or employers)2021-12-31$0
Other income received2021-12-31$54,233
Noncash contributions received2021-12-31$0
Net income (gross income less expenses)2021-12-31$-28,457
Net plan assets at end of year (total assets less liabilities)2021-12-31$572,762
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$601,219
Total contributions received or receivable from employer(s)2021-12-31$3,470
Value of certain deemed distributions of participant loans2021-12-31$0
Value of corrective distributions2021-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$0
2020 : PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2020 401k financial data
Transfers to/from the plan2020-12-31$0
Total plan liabilities at end of year2020-12-31$0
Total plan liabilities at beginning of year2020-12-31$0
Total income from all sources2020-12-31$90,980
Expenses. Total of all expenses incurred2020-12-31$0
Benefits paid (including direct rollovers)2020-12-31$0
Total plan assets at end of year2020-12-31$601,219
Total plan assets at beginning of year2020-12-31$510,239
Total contributions received or receivable from participants2020-12-31$4,773
Expenses. Other expenses not covered elsewhere2020-12-31$0
Contributions received from other sources (not participants or employers)2020-12-31$0
Other income received2020-12-31$85,163
Noncash contributions received2020-12-31$0
Net income (gross income less expenses)2020-12-31$90,980
Net plan assets at end of year (total assets less liabilities)2020-12-31$601,219
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$510,239
Total contributions received or receivable from employer(s)2020-12-31$1,044
Value of certain deemed distributions of participant loans2020-12-31$0
Value of corrective distributions2020-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$0
2019 : PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2019 401k financial data
Transfers to/from the plan2019-12-31$0
Total plan liabilities at end of year2019-12-31$0
Total plan liabilities at beginning of year2019-12-31$0
Total income from all sources2019-12-31$65,022
Expenses. Total of all expenses incurred2019-12-31$0
Benefits paid (including direct rollovers)2019-12-31$0
Total plan assets at end of year2019-12-31$510,239
Total plan assets at beginning of year2019-12-31$445,217
Total contributions received or receivable from participants2019-12-31$3,299
Expenses. Other expenses not covered elsewhere2019-12-31$0
Contributions received from other sources (not participants or employers)2019-12-31$0
Other income received2019-12-31$61,696
Noncash contributions received2019-12-31$0
Net income (gross income less expenses)2019-12-31$65,022
Net plan assets at end of year (total assets less liabilities)2019-12-31$510,239
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$445,217
Total contributions received or receivable from employer(s)2019-12-31$27
Value of certain deemed distributions of participant loans2019-12-31$0
Value of corrective distributions2019-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$0
2018 : PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2018 401k financial data
Transfers to/from the plan2018-12-31$0
Total plan liabilities at end of year2018-12-31$0
Total plan liabilities at beginning of year2018-12-31$0
Total income from all sources2018-12-31$5,906
Expenses. Total of all expenses incurred2018-12-31$0
Benefits paid (including direct rollovers)2018-12-31$0
Total plan assets at end of year2018-12-31$445,217
Total plan assets at beginning of year2018-12-31$439,311
Total contributions received or receivable from participants2018-12-31$2,702
Expenses. Other expenses not covered elsewhere2018-12-31$0
Contributions received from other sources (not participants or employers)2018-12-31$0
Other income received2018-12-31$2,923
Noncash contributions received2018-12-31$0
Net income (gross income less expenses)2018-12-31$5,906
Net plan assets at end of year (total assets less liabilities)2018-12-31$445,217
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$439,311
Total contributions received or receivable from employer(s)2018-12-31$281
Value of certain deemed distributions of participant loans2018-12-31$0
Value of corrective distributions2018-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$0
2017 : PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2017 401k financial data
Transfers to/from the plan2017-12-31$0
Total plan liabilities at end of year2017-12-31$0
Total plan liabilities at beginning of year2017-12-31$0
Total income from all sources2017-12-31$52,900
Expenses. Total of all expenses incurred2017-12-31$0
Benefits paid (including direct rollovers)2017-12-31$0
Total plan assets at end of year2017-12-31$439,311
Total plan assets at beginning of year2017-12-31$386,411
Total contributions received or receivable from participants2017-12-31$1,840
Expenses. Other expenses not covered elsewhere2017-12-31$0
Contributions received from other sources (not participants or employers)2017-12-31$0
Other income received2017-12-31$51,060
Noncash contributions received2017-12-31$0
Net income (gross income less expenses)2017-12-31$52,900
Net plan assets at end of year (total assets less liabilities)2017-12-31$439,311
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$386,411
Total contributions received or receivable from employer(s)2017-12-31$0
Value of certain deemed distributions of participant loans2017-12-31$0
Value of corrective distributions2017-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$0
2016 : PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2016 401k financial data
Transfers to/from the plan2016-12-31$0
Total plan liabilities at end of year2016-12-31$0
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$13,724
Expenses. Total of all expenses incurred2016-12-31$0
Benefits paid (including direct rollovers)2016-12-31$0
Total plan assets at end of year2016-12-31$386,411
Total plan assets at beginning of year2016-12-31$372,687
Total contributions received or receivable from participants2016-12-31$14,011
Expenses. Other expenses not covered elsewhere2016-12-31$0
Contributions received from other sources (not participants or employers)2016-12-31$0
Other income received2016-12-31$-287
Noncash contributions received2016-12-31$0
Net income (gross income less expenses)2016-12-31$13,724
Net plan assets at end of year (total assets less liabilities)2016-12-31$386,411
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$372,687
Total contributions received or receivable from employer(s)2016-12-31$0
Value of certain deemed distributions of participant loans2016-12-31$0
Value of corrective distributions2016-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2015 401k financial data
Transfers to/from the plan2015-12-31$0
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$0
Total income from all sources2015-12-31$15,998
Expenses. Total of all expenses incurred2015-12-31$0
Benefits paid (including direct rollovers)2015-12-31$0
Total plan assets at end of year2015-12-31$372,687
Total plan assets at beginning of year2015-12-31$356,689
Value of fidelity bond covering the plan2015-12-31$0
Assets. Value of tangible personal property2015-12-31$0
Total contributions received or receivable from participants2015-12-31$12,855
Assets. Value of loans (other than to participants)2015-12-31$0
Expenses. Other expenses not covered elsewhere2015-12-31$0
Contributions received from other sources (not participants or employers)2015-12-31$0
Other income received2015-12-31$1,643
Noncash contributions received2015-12-31$0
Net income (gross income less expenses)2015-12-31$15,998
Net plan assets at end of year (total assets less liabilities)2015-12-31$372,687
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$356,689
Assets. Value of participant loans2015-12-31$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2015-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2015-12-31$0
Assets. Value of assets in partnership/joint-venture interests2015-12-31$0
Assets. Value of real-estate (other than employer real property)2015-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022015-12-31$0
Assets. Value of employer securities2015-12-31$0
Assets. Value of employer real property2015-12-31$0
Total contributions received or receivable from employer(s)2015-12-31$1,500
Value of certain deemed distributions of participant loans2015-12-31$0
Value of corrective distributions2015-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total plan liabilities at end of year2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$19,826
Expenses. Total of all expenses incurred2014-12-31$0
Benefits paid (including direct rollovers)2014-12-31$0
Total plan assets at end of year2014-12-31$356,689
Total plan assets at beginning of year2014-12-31$336,863
Value of fidelity bond covering the plan2014-12-31$0
Assets. Value of tangible personal property2014-12-31$0
Total contributions received or receivable from participants2014-12-31$595
Assets. Value of loans (other than to participants)2014-12-31$0
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$18,550
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$19,826
Net plan assets at end of year (total assets less liabilities)2014-12-31$356,689
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$336,863
Assets. Value of participant loans2014-12-31$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2014-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2014-12-31$0
Assets. Value of assets in partnership/joint-venture interests2014-12-31$0
Assets. Value of real-estate (other than employer real property)2014-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022014-12-31$0
Assets. Value of employer securities2014-12-31$0
Assets. Value of employer real property2014-12-31$0
Total contributions received or receivable from employer(s)2014-12-31$681
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$57,036
Expenses. Total of all expenses incurred2013-12-31$12,661
Benefits paid (including direct rollovers)2013-12-31$12,636
Total plan assets at end of year2013-12-31$336,863
Total plan assets at beginning of year2013-12-31$292,488
Value of fidelity bond covering the plan2013-12-31$0
Assets. Value of tangible personal property2013-12-31$0
Total contributions received or receivable from participants2013-12-31$0
Assets. Value of loans (other than to participants)2013-12-31$0
Expenses. Other expenses not covered elsewhere2013-12-31$25
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$54,859
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$44,375
Net plan assets at end of year (total assets less liabilities)2013-12-31$336,863
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$292,488
Assets. Value of participant loans2013-12-31$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2013-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2013-12-31$0
Assets. Value of assets in partnership/joint-venture interests2013-12-31$0
Assets. Value of real-estate (other than employer real property)2013-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022013-12-31$0
Assets. Value of employer securities2013-12-31$0
Assets. Value of employer real property2013-12-31$0
Total contributions received or receivable from employer(s)2013-12-31$2,177
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2013-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$0
Total income from all sources2012-12-31$29,970
Expenses. Total of all expenses incurred2012-12-31$0
Benefits paid (including direct rollovers)2012-12-31$0
Total plan assets at end of year2012-12-31$292,488
Total plan assets at beginning of year2012-12-31$262,572
Value of fidelity bond covering the plan2012-12-31$0
Assets. Value of tangible personal property2012-12-31$0
Total contributions received or receivable from participants2012-12-31$0
Assets. Value of loans (other than to participants)2012-12-31$0
Expenses. Other expenses not covered elsewhere2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$26,989
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$29,970
Net plan assets at end of year (total assets less liabilities)2012-12-31$292,488
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$262,572
Assets. Value of participant loans2012-12-31$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2012-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2012-12-31$0
Assets. Value of assets in partnership/joint-venture interests2012-12-31$0
Assets. Value of real-estate (other than employer real property)2012-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022012-12-31$0
Assets. Value of employer securities2012-12-31$0
Assets. Value of employer real property2012-12-31$0
Total contributions received or receivable from employer(s)2012-12-31$2,981
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2012-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total plan liabilities at end of year2011-12-31$0
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$0
Expenses. Total of all expenses incurred2011-12-31$0
Benefits paid (including direct rollovers)2011-12-31$0
Total plan assets at end of year2011-12-31$0
Total plan assets at beginning of year2011-12-31$241,156
Value of fidelity bond covering the plan2011-12-31$0
Assets. Value of tangible personal property2011-12-31$0
Total contributions received or receivable from participants2011-12-31$0
Assets. Value of loans (other than to participants)2011-12-31$0
Expenses. Other expenses not covered elsewhere2011-12-31$0
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$0
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$0
Net plan assets at end of year (total assets less liabilities)2011-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$241,156
Assets. Value of participant loans2011-12-31$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2011-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2011-12-31$0
Assets. Value of assets in partnership/joint-venture interests2011-12-31$0
Assets. Value of real-estate (other than employer real property)2011-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022011-12-31$0
Assets. Value of employer securities2011-12-31$0
Assets. Value of employer real property2011-12-31$0
Total contributions received or receivable from employer(s)2011-12-31$0
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2011-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$50,482
Expenses. Total of all expenses incurred2010-12-31$0
Benefits paid (including direct rollovers)2010-12-31$0
Total plan assets at end of year2010-12-31$241,156
Total plan assets at beginning of year2010-12-31$190,674
Value of fidelity bond covering the plan2010-12-31$0
Assets. Value of tangible personal property2010-12-31$0
Total contributions received or receivable from participants2010-12-31$0
Assets. Value of loans (other than to participants)2010-12-31$0
Expenses. Other expenses not covered elsewhere2010-12-31$0
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$19,844
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$50,482
Net plan assets at end of year (total assets less liabilities)2010-12-31$241,156
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$190,674
Assets. Value of participant loans2010-12-31$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2010-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2010-12-31$0
Assets. Value of assets in partnership/joint-venture interests2010-12-31$0
Assets. Value of real-estate (other than employer real property)2010-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022010-12-31$0
Assets. Value of employer securities2010-12-31$0
Assets. Value of employer real property2010-12-31$0
Total contributions received or receivable from employer(s)2010-12-31$30,638
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2010-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0

Form 5500 Responses for PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN

2022: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT 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 filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT 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 filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT 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 – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT 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 – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT 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 – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT 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 – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2009: PELEGRINA MEDICAL, INC. EXECUTIVE RETIREMENT 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 – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number664427
Policy instance 1
Insurance contract or identification number664427
Number of Individuals Covered0
Total amount of commissions paid to insurance brokerUSD $697
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?Yes
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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $697
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameAGENT NAME

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