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BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN 401k Plan overview

Plan NameBON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN
Plan identification number 001

BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Stock bonus
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
  • Participant-directed brokerage accounts provided as an investment option under the plan.

401k Sponsoring company profile

BON SECOURS CHARITY HEALTH SYSTEM, INC has sponsored the creation of one or more 401k plans.

Company Name:BON SECOURS CHARITY HEALTH SYSTEM, INC
Employer identification number (EIN):912135195
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012019-01-01PETER KENNIFF2020-12-11
0012019-01-01PETER KENNIFF2020-10-15
0012019-01-01TRACY TILLERY2022-02-09
0012018-01-01PETER KENNIFF2019-10-15
0012017-01-01
0012016-01-01
0012015-05-19PETER KENNIFF PETER KENNIFF2016-10-12
0012015-05-19

Plan Statistics for BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN

401k plan membership statisitcs for BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN

Measure Date Value
2019: BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011,783
Total number of active participants reported on line 7a of the Form 55002019-01-010
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 participants2019-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-010
Number of participants with account balances2019-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-011,958
Total number of active participants reported on line 7a of the Form 55002018-01-011,466
Number of retired or separated participants receiving benefits2018-01-0114
Number of other retired or separated participants entitled to future benefits2018-01-01296
Total of all active and inactive participants2018-01-011,776
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-017
Total participants2018-01-011,783
Number of participants with account balances2018-01-011,777
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-0114
2017: BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-011,592
Total number of active participants reported on line 7a of the Form 55002017-01-011,454
Number of retired or separated participants receiving benefits2017-01-0111
Number of other retired or separated participants entitled to future benefits2017-01-01192
Total of all active and inactive participants2017-01-011,657
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-011
Total participants2017-01-011,658
Number of participants with account balances2017-01-011,643
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-0132
2016: BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,549
Total number of active participants reported on line 7a of the Form 55002016-01-011,392
Number of retired or separated participants receiving benefits2016-01-016
Number of other retired or separated participants entitled to future benefits2016-01-01193
Total of all active and inactive participants2016-01-011,591
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-011
Total participants2016-01-011,592
Number of participants with account balances2016-01-011,568
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-0131
2015: BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-19695
Total number of active participants reported on line 7a of the Form 55002015-05-191,337
Number of retired or separated participants receiving benefits2015-05-197
Number of other retired or separated participants entitled to future benefits2015-05-19200
Total of all active and inactive participants2015-05-191,544
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-05-195
Total participants2015-05-191,549
Number of participants with account balances2015-05-191,028
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-05-199

Financial Data on BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN

Measure Date Value
2019 : BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total transfer of assets from this plan2019-12-31$32,321,492
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$7,569,633
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$1,745,979
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$1,696,576
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$3,316,819
Value of total assets at end of year2019-12-31$0
Value of total assets at beginning of year2019-12-31$26,497,838
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$49,403
Total interest from all sources2019-12-31$22,319
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$231,744
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$231,744
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Participant contributions at end of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$314,971
Assets. Other investments not covered elsewhere at end of year2019-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$112,643
Other income not declared elsewhere2019-12-31$4,553
Administrative expenses (other) incurred2019-12-31$49,403
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$5,823,654
Value of net assets at end of year (total assets less liabilities)2019-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$26,497,838
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$25,635,570
Value of interest in pooled separate accounts at end of year2019-12-31$0
Value of interest in pooled separate accounts at beginning of year2019-12-31$0
Interest on participant loans2019-12-31$4,878
Interest earned on other investments2019-12-31$17,441
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$547,297
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$3,998,751
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$3,204,176
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$1,696,576
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31Yes
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31GRANT THORNTON LLP
Accountancy firm EIN2019-12-31366055558
2018 : BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$2,695,026
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$1,323,764
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$1,279,043
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$3,917,562
Value of total assets at end of year2018-12-31$26,497,838
Value of total assets at beginning of year2018-12-31$25,126,576
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$44,721
Total interest from all sources2018-12-31$28,213
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$803,970
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$803,970
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Participant contributions at end of year2018-12-31$314,971
Participant contributions at beginning of year2018-12-31$317,822
Assets. Other investments not covered elsewhere at end of year2018-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2018-12-31$741,572
Administrative expenses (other) incurred2018-12-31$23
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$1,371,262
Value of net assets at end of year (total assets less liabilities)2018-12-31$26,497,838
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$25,126,576
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$14,706
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$25,635,570
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$23,656,438
Interest on participant loans2018-12-31$17,498
Interest earned on other investments2018-12-31$10,715
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$20,518
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$20,518
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$547,297
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$390,226
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-2,054,719
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$3,917,562
Employer contributions (assets) at end of year2018-12-31$0
Employer contributions (assets) at beginning of year2018-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$1,279,043
Contract administrator fees2018-12-31$29,992
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31Yes
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31GRANT THORNTON LLP
Accountancy firm EIN2018-12-31366055558
2017 : BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-12-31$113,570
Total unrealized appreciation/depreciation of assets2017-12-31$113,570
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$6,688,600
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$1,503,678
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$1,449,002
Expenses. Certain deemed distributions of participant loans2017-12-31$6,470
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$3,357,965
Value of total assets at end of year2017-12-31$25,126,576
Value of total assets at beginning of year2017-12-31$19,941,654
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$48,206
Total interest from all sources2017-12-31$24,545
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$727,365
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$727,365
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Participant contributions at end of year2017-12-31$317,822
Participant contributions at beginning of year2017-12-31$274,730
Assets. Other investments not covered elsewhere at end of year2017-12-31$741,572
Assets. Other investments not covered elsewhere at beginning of year2017-12-31$644,238
Administrative expenses (other) incurred2017-12-31$27,442
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$5,184,922
Value of net assets at end of year (total assets less liabilities)2017-12-31$25,126,576
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$19,941,654
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$20,764
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$23,656,438
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$18,139,506
Interest on participant loans2017-12-31$11,415
Interest earned on other investments2017-12-31$13,130
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$20,518
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$18,936
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$18,936
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$390,226
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$743,401
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$2,465,155
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$3,357,965
Employer contributions (assets) at end of year2017-12-31$0
Employer contributions (assets) at beginning of year2017-12-31$120,843
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$1,449,002
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31GRANT THORNTON LLP
Accountancy firm EIN2017-12-31366055558
2016 : BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-12-31$21,059
Total unrealized appreciation/depreciation of assets2016-12-31$21,059
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$4,362,772
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$696,796
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$658,470
Expenses. Certain deemed distributions of participant loans2016-12-31$3,839
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$3,145,382
Value of total assets at end of year2016-12-31$19,941,654
Value of total assets at beginning of year2016-12-31$16,275,678
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$34,487
Total interest from all sources2016-12-31$34,155
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$617,177
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$617,177
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Participant contributions at end of year2016-12-31$274,730
Participant contributions at beginning of year2016-12-31$225,276
Assets. Other investments not covered elsewhere at end of year2016-12-31$644,238
Assets. Other investments not covered elsewhere at beginning of year2016-12-31$680,755
Administrative expenses (other) incurred2016-12-31$17,724
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$3,665,976
Value of net assets at end of year (total assets less liabilities)2016-12-31$19,941,654
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$16,275,678
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$16,763
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$18,139,506
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$14,175,067
Interest on participant loans2016-12-31$13,102
Interest earned on other investments2016-12-31$21,053
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$18,936
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$9,893
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$9,893
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$743,401
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$1,123,665
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$544,999
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$3,145,382
Employer contributions (assets) at end of year2016-12-31$120,843
Employer contributions (assets) at beginning of year2016-12-31$61,022
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$658,470
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31GRANT THORNTON LLP
Accountancy firm EIN2016-12-31366055558
2015 : BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets2015-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2015-12-31$0
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total transfer of assets to this plan2015-12-31$847,654
Total transfer of assets from this plan2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$190
Expenses. Interest paid2015-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022015-12-31$0
Total income from all sources (including contributions)2015-12-31$1,860,233
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$820,105
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$787,957
Expenses. Certain deemed distributions of participant loans2015-12-31$9,687
Value of total corrective distributions2015-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$2,051,047
Value of total assets at end of year2015-12-31$16,214,658
Value of total assets at beginning of year2015-12-31$14,327,066
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$22,461
Total income from rents2015-12-31$0
Total interest from all sources2015-12-31$37,663
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$565,513
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$565,513
Assets. Real estate other than employer real property at end of year2015-12-31$0
Assets. Real estate other than employer real property at beginning of year2015-12-31$0
Administrative expenses professional fees incurred2015-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2015-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2015-12-31$0
Was this plan covered by a fidelity bond2015-12-31No
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$0
Participant contributions at end of year2015-12-31$225,276
Participant contributions at beginning of year2015-12-31$172,763
Participant contributions at end of year2015-12-31$0
Participant contributions at beginning of year2015-12-31$0
Assets. Other investments not covered elsewhere at end of year2015-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2015-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$1
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$4
Assets. Loans (other than to participants) at end of year2015-12-31$0
Assets. Loans (other than to participants) at beginning of year2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$190
Other income not declared elsewhere2015-12-31$0
Administrative expenses (other) incurred2015-12-31$8,736
Liabilities. Value of operating payables at end of year2015-12-31$0
Liabilities. Value of operating payables at beginning of year2015-12-31$0
Total non interest bearing cash at end of year2015-12-31$0
Total non interest bearing cash at beginning of year2015-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Income. Non cash contributions2015-12-31$0
Value of net income/loss2015-12-31$1,040,128
Value of net assets at end of year (total assets less liabilities)2015-12-31$16,214,658
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$14,326,876
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Assets. partnership/joint venture interests at end of year2015-12-31$0
Assets. partnership/joint venture interests at beginning of year2015-12-31$0
Investment advisory and management fees2015-12-31$13,725
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$14,012,076
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$11,947,301
Value of interest in pooled separate accounts at end of year2015-12-31$0
Value of interest in pooled separate accounts at beginning of year2015-12-31$0
Interest on participant loans2015-12-31$8,028
Income. Interest from loans (other than to participants)2015-12-31$0
Interest earned on other investments2015-12-31$28,730
Income. Interest from US Government securities2015-12-31$0
Income. Interest from corporate debt instruments2015-12-31$0
Value of interest in master investment trust accounts at end of year2015-12-31$0
Value of interest in master investment trust accounts at beginning of year2015-12-31$0
Value of interest in common/collective trusts at end of year2015-12-31$0
Value of interest in common/collective trusts at beginning of year2015-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$853,640
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$775,176
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$775,176
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$905
Assets. Value of investments in 103.12 investment entities at end of year2015-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2015-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$1,123,665
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$1,431,822
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$0
Asset value of US Government securities at end of year2015-12-31$0
Asset value of US Government securities at beginning of year2015-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-793,990
Net investment gain/loss from pooled separate accounts2015-12-31$0
Net investment gain or loss from common/collective trusts2015-12-31$0
Net gain/loss from 103.12 investment entities2015-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Assets. Invements in employer securities at end of year2015-12-31$0
Assets. Invements in employer securities at beginning of year2015-12-31$0
Assets. Value of employer real property at end of year2015-12-31$0
Assets. Value of employer real property at beginning of year2015-12-31$0
Contributions received in cash from employer2015-12-31$2,051,047
Employer contributions (assets) at end of year2015-12-31$0
Employer contributions (assets) at beginning of year2015-12-31$0
Income. Dividends from common stock2015-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$787,957
Asset. Corporate debt instrument preferred debt at end of year2015-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2015-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2015-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2015-12-31$0
Contract administrator fees2015-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2015-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2015-12-31$0
Liabilities. Value of benefit claims payable at end of year2015-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2015-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2015-12-31$0
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Aggregate proceeds on sale of assets2015-12-31$0
Aggregate carrying amount (costs) on sale of assets2015-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2015-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2015-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31GRANT THORNTON LLP
Accountancy firm EIN2015-12-31366055558

Form 5500 Responses for BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN

2019: BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedYes
2019-01-01This submission is the final filingYes
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 – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION 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 – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION 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 – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION 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 – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: BON SECOURS GOOD SAMARITAN HOSPITAL 403(B) PENSION PLAN 2015 form 5500 responses
2015-05-19Type of plan entitySingle employer plan
2015-05-19First time form 5500 has been submittedYes
2015-05-19Submission has been amendedNo
2015-05-19This submission is the final filingNo
2015-05-19This return/report is a short plan year return/report (less than 12 months)Yes
2015-05-19Plan is a collectively bargained planNo
2015-05-19Plan funding arrangement – InsuranceYes
2015-05-19Plan funding arrangement – TrustYes
2015-05-19Plan benefit arrangement – InsuranceYes
2015-05-19Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberL7550330
Policy instance 1
Insurance contract or identification numberL7550330
Number of Individuals Covered144
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $731
Total amount of fees paid to insurance companyUSD $0
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?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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $731
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number95894-02
Policy instance 2
Insurance contract or identification number95894-02
Number of Individuals Covered0
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number69412
Policy instance 2
Insurance contract or identification number69412
Number of Individuals Covered0
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 Administration1
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
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberL7550330
Policy instance 1
Insurance contract or identification numberL7550330
Number of Individuals Covered152
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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?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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number95894-02
Policy instance 3
Insurance contract or identification number95894-02
Number of Individuals Covered155
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 Administration1
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
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberL7550330
Policy instance 1
Insurance contract or identification numberL7550330
Number of Individuals Covered156
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $797
Total amount of fees paid to insurance companyUSD $0
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?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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $797
Insurance broker organization code?3
Insurance broker nameHEALTHCARE COMMUNITY CORP. SECUR.
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number69412
Policy instance 2
Insurance contract or identification number69412
Number of Individuals Covered209
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 Administration1
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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