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FORM 5500 DATA

O'Connor Hospital Defined Contribution Plan

Overview

Plan Information

  • Plan Year01/01/2017 — 12/31/2017
  • Date of Plan01/01/1998
  • Net Assets as of 12/31/2017 $7,569,955
  • Plan Number3
  • Plan Type Single Employer
  • Is the plan collectively bargained? No
  • Did the plan file for an extension of time or the DFVC Program?Yes
  • Plan Funding ArrangementInsurance Trust
  • Plan Benefit ArrangementInsurance Trust

Participant Information as of 12/31/2017

  • Active (Eligible) Participants175
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits49
  • Subtotal224
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits0
  • Total224
  • Total number of participants as of 01/01/2017227
  • Number of participants with account balances180
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested0

Expenses

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

Sponsor Information

  • Address460 Andes Rd.
  • CityDelhi
  • StateNY
  • Zip13753
  • Telephone(607) 746-0328
  • EIN16-1540394
  • Industry Code622000
  • Named AdministratorBarbara Green

Audit Information

  • Audit StatusAudited
  • AuditorKpmg, LLP
  • Auditor EIN13-5565207
  • Audit Opinion Disclaimer
  • Audit TypeLimited Scope Audit

Benefits Provided Under the Plan

Code Benefit Description
2A Age/Service Weighted or New Comparability or Similar Plan Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New Comparability or Similar Plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the threshold or additional rate allowed under the permitted disparity rules of section 401(l)
2F ERISA section 404(c) Plan This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
2L Code section 403(b)(1) arrangement A 403(b) plan, also known as a tax-sheltered annuity (TSA) plan, is a retirement plan for certain employees of public schools, employees of certain tax-exempt organizations, and certain ministers.
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.
3D 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.

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 $1,000,000
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 $1,720,762
Contributions $593,026
Cash Contributions $593,026
Cash from Employers $321,421
Cash from Participants $271,605
Others (including rollovers) $0
Noncash Contributions $0
Total Earnings on Investments $1,112,389
Total Interest $14,519
Interest-Bearing Cash $0
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $14,519
Interest from Other Investments $0
Total Dividends $93,545
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 $0
Net investment gain (loss) from pooled separate accounts $201
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 $1,004,124
Other Income $15,347
Expenses $872,929
Total Benefit Payments $818,294
Directly to participants or beneficiaries, including direct rollovers $818,294
To insurance carriers for the provision of benefits $0
Other Benefit Payment Fees $0
Corrective Distributions $0
Certain deemed distributions of participant loans $0
Interest expense $0
Total Administrative Expenses $54,635
Professional Fees $0
Contract Administrator Fees $23,427
Investment Advisory and management fees $31,208
Other Administrative Fees $0
Net Income $847,833
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2017 12/31/2016 Change YOY
Total Assets $7,569,955 $6,722,122 12.61%
Total noninterest-bearing cash $0 $0 0.0%
Receivables $27,337 $29,184 -6.33%
Employer Contributions $27,337 $29,184 -6.33%
Participant Contributions $0 $0 0.0%
Other Contributions $0 $0 0.0%
General Investments $0 $0 0.0%
Interest-bearing cash $0 $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 $275,838 $263,056 4.86%
Value of interest in common/collective trusts $0 $0 0.0%
Value of interest in pooled separate accounts $4,792 $4,591 4.38%
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 $6,885,396 $6,039,935 14.00%
Value of funds held in insurance co. general account $376,592 $385,356 -2.27%
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 $0 $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) $0 $0 0.0%
Net Assets $7,569,955 $6,722,122 12.61%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

  • TIAA

Other Service Providers Receiving Direct or Indirect Compensation

Name Nature of Service Relationship to Plan Sponsor Direct Compensation Paid by Plan Indirect Compensation Paid by Plan Total Compensation
Halliday Financial Investment advisory (participants), Investment advisory (plan), Direct payment from the plan NONE $31,208 $0 $31,208
P&A Retirement Plan Services, Inc Contract Administrator, Recordkeeping and information management (computing, tabulating, data processing, etc.), Participant loan processing, Direct payment from the plan, Recordkeeping fees, Sub-transfer agency fees, Distribution (12b-1) fees NONE $23,427 $0 $23,427
Total $54,635 $0 $54,635

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
Tiaa Real Estate Tiaa-Cref DFE: Pooled Separate Account $4,792
Total $4,792

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Tiaa-Cref 52
EIN 13-1624203
Industry Code 69345
Contract Number 368665
Contract Year 01/01/2017 — 12/31/2017
Value in General Account at Year End $376,592
Value in Separate Accounts at Year End $170,581
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 $385,356
Additions $36,484
Contributions Deposited during the year $0
Dividends and credits $0
Interest credited during the year $15,347
Transferred from separate account $21,137
Other $0
Total of Balance and Additions $421,840
Deductions $45,248
Disbursed from fund to pay benefits or purchase annuities during the year $10,711
Administration charge made by carrier $0
Transferred to Separate Account $25,657
Other $8,880
Balance at the end of the current year $376,592