401k Plan data: LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN plan

LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 401k Plan overview

Plan Name	LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN
Plan identification number	013

LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

SUTTER BAY HOSPITALS has sponsored the creation of one or more 401k plans.

Company Name: SUTTER BAY HOSPITALS

Employer identification number (EIN): 940562680

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about SUTTER BAY HOSPITALS

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C0015273

More information about SUTTER BAY HOSPITALS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
013 2016-01-01 VICTORIA FLEMMING 2017-07-17
013 2015-01-01 VICTORIA FLEMMING 2016-09-30
013 2014-01-01 VICTORIA FLEMMING 2015-10-13
013 2013-01-01 SIRI NELSON
013 2012-01-01 SIRI NELSON
013 2011-01-01 SIRI NELSON
013 2010-07-01 SIRI NELSON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
013	2016-01-01	VICTORIA FLEMMING	2017-07-17
013	2015-01-01	VICTORIA FLEMMING	2016-09-30
013	2014-01-01	VICTORIA FLEMMING	2015-10-13
013	2013-01-01	SIRI NELSON
013	2012-01-01	SIRI NELSON
013	2011-01-01	SIRI NELSON
013	2010-07-01	SIRI NELSON

Plan Statistics for LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN

401k plan membership statisitcs for LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN

Measure Date Value
2013: LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 22
Number of retired or separated participants receiving benefits 2013-01-01 2
Number of other retired or separated participants entitled to future benefits 2013-01-01 72
Total of all active and inactive participants 2013-01-01 96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 4
Total participants 2013-01-01 100
Number of participants with account balances 2013-01-01 100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 23
Number of retired or separated participants receiving benefits 2012-01-01 2
Number of other retired or separated participants entitled to future benefits 2012-01-01 74
Total of all active and inactive participants 2012-01-01 99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 4
Total participants 2012-01-01 103
Number of participants with account balances 2012-01-01 103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 23
Number of retired or separated participants receiving benefits 2011-01-01 3
Number of other retired or separated participants entitled to future benefits 2011-01-01 74
Total of all active and inactive participants 2011-01-01 100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 3
Total participants 2011-01-01 103
Number of participants with account balances 2011-01-01 103
2010: LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-07-01 114
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 84
Number of retired or separated participants receiving benefits 2010-07-01 0
Number of other retired or separated participants entitled to future benefits 2010-07-01 26
Total of all active and inactive participants 2010-07-01 110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-07-01 3
Total participants 2010-07-01 113
Number of participants with account balances 2010-07-01 113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-07-01 0

Measure	Date	Value
2013: LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	22
Number of retired or separated participants receiving benefits	2013-01-01	2
Number of other retired or separated participants entitled to future benefits	2013-01-01	72
Total of all active and inactive participants	2013-01-01	96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	4
Total participants	2013-01-01	100
Number of participants with account balances	2013-01-01	100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	23
Number of retired or separated participants receiving benefits	2012-01-01	2
Number of other retired or separated participants entitled to future benefits	2012-01-01	74
Total of all active and inactive participants	2012-01-01	99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	4
Total participants	2012-01-01	103
Number of participants with account balances	2012-01-01	103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	23
Number of retired or separated participants receiving benefits	2011-01-01	3
Number of other retired or separated participants entitled to future benefits	2011-01-01	74
Total of all active and inactive participants	2011-01-01	100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	3
Total participants	2011-01-01	103
Number of participants with account balances	2011-01-01	103
2010: LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-07-01	114
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	84
Number of retired or separated participants receiving benefits	2010-07-01	0
Number of other retired or separated participants entitled to future benefits	2010-07-01	26
Total of all active and inactive participants	2010-07-01	110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-07-01	3
Total participants	2010-07-01	113
Number of participants with account balances	2010-07-01	113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-07-01	0

Financial Data on LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN

Measure	Date	Value
2013 : LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$18,843
Expenses. Total of all expenses incurred	2013-12-31	$17,634
Benefits paid (including direct rollovers)	2013-12-31	$17,634
Total plan assets at end of year	2013-12-31	$335,701
Total plan assets at beginning of year	2013-12-31	$334,492
Value of fidelity bond covering the plan	2013-12-31	$10,000,000
Other income received	2013-12-31	$18,843
Net income (gross income less expenses)	2013-12-31	$1,209
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$335,701
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$334,492
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$13,964
Expenses. Total of all expenses incurred	2012-12-31	$2,500
Benefits paid (including direct rollovers)	2012-12-31	$2,500
Total plan assets at end of year	2012-12-31	$334,492
Total plan assets at beginning of year	2012-12-31	$323,028
Value of fidelity bond covering the plan	2012-12-31	$10,000,000
Other income received	2012-12-31	$13,964
Net income (gross income less expenses)	2012-12-31	$11,464
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$334,492
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$323,028
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$10,565
Expenses. Total of all expenses incurred	2011-12-31	$41,134
Benefits paid (including direct rollovers)	2011-12-31	$41,134
Total plan assets at end of year	2011-12-31	$323,028
Total plan assets at beginning of year	2011-12-31	$353,597
Value of fidelity bond covering the plan	2011-12-31	$10,000,000
Other income received	2011-12-31	$10,565
Net income (gross income less expenses)	2011-12-31	$-30,569
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$323,028
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$353,597
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$12,176
Expenses. Total of all expenses incurred	2010-12-31	$7,676
Benefits paid (including direct rollovers)	2010-12-31	$7,676
Total plan assets at end of year	2010-12-31	$353,597
Total plan assets at beginning of year	2010-12-31	$349,097
Value of fidelity bond covering the plan	2010-12-31	$10,000,000
Other income received	2010-12-31	$12,176
Net income (gross income less expenses)	2010-12-31	$4,500
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$353,597
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$349,097
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0

Form 5500 Responses for LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN

2013: LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: LAKESIDE COMMUNITY HOSPITAL TAX DEFERRED ANNUITY RETIREMENT PLAN 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

FA068464

Policy instance

Insurance contract or identification number	FA068464
Number of Individuals Covered	100
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 number

FA068464

Policy instance

Insurance contract or identification number	FA068464
Number of Individuals Covered	103
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 number

FA068464

Policy instance

Insurance contract or identification number	FA068464
Number of Individuals Covered	103
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 number

FA068464

Policy instance

Insurance contract or identification number	FA068464
Number of Individuals Covered	113
Insurance policy start date	2010-07-01
Insurance policy end date	2010-12-31
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SUTTER BAY HOSPITALS
Employer identification number (EIN):	940562680
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C0015273