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FORM 5500 DATA

Adventist Health 401k Plan

Overview

Plan Information

  • Plan Year01/01/2019 — 12/31/2019
  • Date of Plan01/01/2019
  • Net Assets as of 12/31/2019 $20,046,381
  • Plan Number7
  • Plan Type Single Employer
  • Is the plan collectively bargained?Yes
  • Did the plan file for an extension of time or the DFVC Program?Yes
  • Report DescriptionThis is the first report filed for the plan.
  • Plan Funding ArrangementInsurance Trust
  • Plan Benefit ArrangementInsurance Trust

Participant Information as of 12/31/2019

  • Active (Eligible) Participants2,268
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits192
  • Subtotal2,460
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits2
  • Total2,462
  • Total number of participants as of 01/01/20190
  • Number of participants with account balances2,052
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested93

Expenses

  • Total Benefit Payments$0
  • Corrective Distributions$0
  • Administrative Service Providers$0
  • Other Expenses$0
  • Total Expenses$0
  • Total Transfers$0

Sponsor Information

  • AddressOne Adventist Health Way
  • CityRoseville
  • StateCA
  • Zip95661
  • Telephone(916) 406-0747
  • EIN95-3484589
  • Industry Code622000

Plan Administrator Information

  • Administrator NameAdventist Health Retirement Committee (Non-Church)
  • AddressOne Adventist Health Way
  • CityRoseville
  • StateCA
  • Zip95661
  • Telephone(916) 406-0747
  • Administrator EIN95-3484589

Audit Information

  • Audit StatusAudited
  • AuditorMoss Adams
  • Auditor EIN91-0189318
  • Audit Opinion Disclaimer
  • Audit TypeLimited Scope Audit

Benefits Provided Under the Plan

Code Benefit Description
2E Profit-sharing A defined contribution plan that allows employer discretionary contributions. These plans often contain a 401(k) feature.
2G 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.
2J Code section 401(k) feature A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
2K Code section 401(m) arrangement Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contributions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
2R Brokerage Window Participant-directed brokerage accounts provided as an investment option under the plan.
2S Automatic Enrollment Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
2T Participant-directed Account Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
3H Controlled Group Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

Questions and Answers

Question Answer Amount
During the plan year did the employer fail to transmit to the plan any participant contributions within the time period described in 29 CFT 2510.3-102? No
Were any loans by the plan or fixed income obligations due the plan in default as of the close of plan year or classified during the year as uncollectible? Disregard participant loans secured by participant's account balance. No
Were any leases to which the plan was a party in default or classified during the year as uncollectible? No
Were there any nonexempt transactions with any party-in-interest? No
Was this plan covered by a fidelity bond? Yes $10,000,000
Did the plan have a loss, whether or not reimbursed by the plan's fidelity bond, that was caused by fraud or dishonesty? No
Did the plan hold any assets whose current value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan receive any noncash contributions whose value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan have assets held for investment? Yes
Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets? No
Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC? No
Has the plan failed to provide any benefit when due under the plan? No
If this is an individual account plan, was there a blackout period? No
If there was a blackout period, have you either provided the required notice or one of the exceptions to providing the notice applied under 29 CFR 2520.101-3? No

Financials

Income and Expense Statement

Income $20,234,104
Contributions $18,842,554
Cash Contributions $18,842,554
Cash from Employers $6,767,445
Cash from Participants $10,633,807
Others (including rollovers) $1,441,302
Noncash Contributions $0
Total Earnings on Investments $1,391,550
Total Interest $3,088
Interest-Bearing Cash $1,467
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $522
Interest from Other Investments $1,099
Total Dividends $0
Preferred Stock $0
Common Stock $0
Rents $0
Net gain (loss) on sale of assets $0
Aggregate Proceeds $0
Aggregate Carrying Amount $0
Total Unrealized Appreciation (depreciation) of assets $0
Real Estate $0
Other $0
Net investment gain (loss) from common/collective trusts $1,385,152
Net investment gain (loss) from pooled separate accounts $3,310
Net investment gain (loss) from master trust investment accounts $0
Net investment gain (loss) from 103-12 investment entities $0
Net investment gain (loss) from registered investment companies $0
Other Income $0
Expenses $295,511
Total Benefit Payments $179,883
Directly to participants or beneficiaries, including direct rollovers $179,883
To insurance carriers for the provision of benefits $0
Other Benefit Payment Fees $0
Corrective Distributions $114,565
Certain deemed distributions of participant loans $0
Interest expense $0
Total Administrative Expenses $1,063
Professional Fees $0
Contract Administrator Fees $0
Investment Advisory and management fees $0
Other Administrative Fees $1,063
Net Income $19,938,593
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2019 12/31/2018 Change YOY
Total Assets $20,160,946 $0 0.0%
Total noninterest-bearing cash $0 $0 0.0%
Receivables $3,416,392 $0 0.0%
Employer Contributions $3,416,392 $0 0.0%
Participant Contributions $0 $0 0.0%
Other Contributions $0 $0 0.0%
General Investments $102,496 $0 0.0%
Interest-bearing cash $102,496 $0 0.0%
U.S. Government Securities $0 $0 0.0%
Corporate Debt Instruments $0 $0 0.0%
Preferred $0 $0 0.0%
All Other $0 $0 0.0%
Corporate Stocks $0 $0 0.0%
Preferred $0 $0 0.0%
Common $0 $0 0.0%
Partnership/joint venture interests $0 $0 0.0%
Real estate (other than employer real property) $0 $0 0.0%
Loans (other than to participants) $0 $0 0.0%
Participants Loans $45,033 $0 0.0%
Value of interest in common/collective trusts $16,477,594 $0 0.0%
Value of interest in pooled separate accounts $57,685 $0 0.0%
Value of interest in master trust investment accounts $0 $0 0.0%
Value of interest in 103-12 investment entities $0 $0 0.0%
Value of interest in registered investment companies $0 $0 0.0%
Value of funds held in insurance co. general account $61,746 $0 0.0%
Other Investments $0 $0 0.0%
Employer-related Investments $0 $0 0.0%
Employer Securities $0 $0 0.0%
Employer Real Property $0 $0 0.0%
Buildings and other property used in plan operation $0 $0 0.0%
Total Liabilities $114,565 $0 0.0%
Benefit Claims Payable (1) $0 $0 0.0%
Operating Payables (1) $0 $0 0.0%
Acquisition Indebtedness (1) $0 $0 0.0%
Other liabilities (1) $114,565 $0 0.0%
Net Assets $20,046,381 $0 0.0%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

  • Blackrock Institutional Trust Co.
  • State Street Bank & Trust Company
  • Prudential

Other Service Providers Receiving Direct or Indirect Compensation

There are no service providers listed for this plan.

Indirect Compensation

There are no service providers with indirect compensation listed for this plan.

Service Providers Who Fail or Refuse to Provide Information

There are no service providers who failed or refused to provide information.

Termination Information on Accountants and Enrolled Actuaries

There is no termination information for this plan.

Investments

Investments

Name of Investment Investment Manager Type of Investment Dollar Value
Lifepath Index 2050 Fund Blackrock Institutional Trust Company DFE: Common/Collective Trust $2,269,618
Lifepath Index 2045 Fund Blackrock Institutional Trust Company DFE: Common/Collective Trust $2,076,224
Lifepath Index 2025 Fund Blackrock Institutional Trust Company DFE: Common/Collective Trust $1,777,186
Lifepath Index 2055 Fund Blackrock Institutional Trust Company DFE: Common/Collective Trust $1,703,244
Lifepath Index 2040 Fund Blackrock Institutional Trust Company DFE: Common/Collective Trust $1,660,800
Lifepath Index 2030 Fund Blackrock Institutional Trust Company DFE: Common/Collective Trust $1,499,788
Lifepath Index 2035 Fund Blackrock Institutional Trust Company DFE: Common/Collective Trust $1,417,565
Lifepath Index Retirement Fd Blackrock Institutional Trust Company DFE: Common/Collective Trust $1,213,501
Russell 3000 Index Fund Blackrock Institutional Trust Company DFE: Common/Collective Trust $1,111,039
Lifepath Index 2060 Fund Blackrock Institutional Trust Company DFE: Common/Collective Trust $767,442
Msci Acwi Ex Us Imi Index Fd Blackrock Institutional Trust Company DFE: Common/Collective Trust $551,984
Us Debt Index Fund Blackrock Institutional Trust Company DFE: Common/Collective Trust $429,203
Inc Flex Tgt Vanguard Bal Ind Prudential Ret.Insurance & Annuity Company DFE: Pooled Separate Account $57,685
Total $16,535,279

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Metropolitan Life Insurance Company 0
EIN 13-5581829
Industry Code 65978
Contract Number 37288
Contract Year 01/01/2019 — 12/31/2019
Value in General Account at Year End $61,746
Value in Separate Accounts at Year End $0
Insurance Fees and Commissions $0
Persons Receiving Commissions and Fees There are no brokers listed for this plan.
Allocated Funds
Type of Contract Unspecified
Basis of premium rates
Premiums paid to carrier $0
Premiums due but unpaid at the end of the year $0
If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount $0
Specify the nature of the costs
Unallocated Funds
Type of Contract Guaranteed Investment
Balance at the end of the previous year $0
Additions $96,297
Contributions Deposited during the year $95,198
Dividends and credits $0
Interest credited during the year $1,099
Transferred from separate account $0
Other $0
Total of Balance and Additions $96,297
Deductions $34,551
Disbursed from fund to pay benefits or purchase annuities during the year $34,551
Administration charge made by carrier $0
Transferred to Separate Account $0
Other $0
Balance at the end of the current year $61,746
Prudential Retirement Insurance and Annuity Company 0
EIN 06-1050034
Industry Code 93629
Contract Number 041891
Contract Year 01/01/2019 — 12/31/2019
Value in General Account at Year End $0
Value in Separate Accounts at Year End $57,685
Insurance Fees and Commissions $0
Persons Receiving Commissions and Fees There are no brokers listed for this plan.
Allocated Funds
Type of Contract Unspecified
Basis of premium rates
Premiums paid to carrier $0
Premiums due but unpaid at the end of the year $0
If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount $0
Specify the nature of the costs
Unallocated Funds
Type of Contract Unspecified
Balance at the end of the previous year $0
Additions $0
Contributions Deposited during the year $0
Dividends and credits $0
Interest credited during the year $0
Transferred from separate account $0
Other $0
Total of Balance and Additions $0
Deductions $0
Disbursed from fund to pay benefits or purchase annuities during the year $0
Administration charge made by carrier $0
Transferred to Separate Account $0
Other $0
Balance at the end of the current year $0