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FORM 5500 DATA

Central Georgia Health Ventures, Inc. 401K Plan

Overview

Plan Information

  • Plan Year01/01/2014 — 12/31/2014
  • Date of Plan01/01/1996
  • Net Assets as of 12/31/2014 $1,645,601
  • Plan Number2
  • 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 12/31/2014

  • Active (Eligible) Participants55
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits55
  • Subtotal110
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits0
  • Total110
  • Total number of participants as of 01/01/2014122
  • Number of participants with account balances110
  • 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

  • Address777 Hemlock Street
  • CityMacon
  • StateGA
  • Zip31201
  • Telephone(478) 633-1000
  • EIN58-2164989
  • Industry Code622000
  • Named AdministratorNinfa Saunders
  • Named Plan SponsorRhonda S. Perry

Plan Administrator Information

  • Administrator NameCentral Georgia Health Ventures Inc
  • Address777 Hemlock Street
  • CityMacon
  • StateGA
  • Zip31201
  • Telephone(478) 633-1000
  • Administrator EIN58-2164989

Audit Information

  • Audit StatusAudited
  • AuditorHoward, Moore & Mcduffie, P.C.
  • Auditor EIN58-1484212
  • 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)
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.
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.
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 $149,183
Contributions $47,488
Cash Contributions $47,488
Cash from Employers $21,906
Cash from Participants $25,582
Others (including rollovers) $0
Noncash Contributions $0
Total Earnings on Investments $101,695
Total Interest $10,122
Interest-Bearing Cash $0
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $613
Interest from Other Investments $9,509
Total Dividends $56,288
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 $0
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 $35,285
Other Income $0
Expenses $158,471
Total Benefit Payments $154,388
Directly to participants or beneficiaries, including direct rollovers $154,388
To insurance carriers for the provision of benefits $0
Other Benefit Payment Fees $0
Corrective Distributions $0
Certain deemed distributions of participant loans $-1,530
Interest expense $0
Total Administrative Expenses $5,613
Professional Fees $0
Contract Administrator Fees $5,613
Investment Advisory and management fees $0
Other Administrative Fees $0
Net Income $-9,288
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2014 12/31/2013 Change YOY
Total Assets $1,645,601 $1,654,889 -0.56%
Total noninterest-bearing cash $10,829 $15,233 -28.91%
Receivables $0 $0 0.0%
Employer Contributions $0 $0 0.0%
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 $10,880 $17,941 -39.36%
Value of interest in common/collective trusts $0 $0 0.0%
Value of interest in pooled separate accounts $0 $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 $1,187,728 $1,244,841 -4.59%
Value of funds held in insurance co. general account $436,164 $376,874 15.73%
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 $1,645,601 $1,654,889 -0.56%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

  • Variable Annuity Life Insurance Com
  • Valic Retirement Service Company

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
Valic Retirement Services Company Participant loan processing, Custodial (securities), Investment management, Legal, Securities brokerage, Other services, Investment management fees paid indirectly by plan, Shareholder servicing fees, Sub-transfer agency fees, Finders' fees/placement fees, Distribution (12b-1) fees, Recordkeeping fees, Other investment fees and expenses, Other fees No Relationship $5,674 $0 $5,674
Total $5,674 $0 $5,674

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

No investments information available for this plan.

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Variable Annuity Life Insurance Co. 113
EIN 74-1625348
Industry Code 70238
Contract Number 04082
Contract Year 01/01/2014 — 12/31/2014
Value in General Account at Year End $434,587
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 $376,873
Additions $83,548
Contributions Deposited during the year $10,964
Dividends and credits $0
Interest credited during the year $9,488
Transferred from separate account $63,096
Other $0
Total of Balance and Additions $460,421
Deductions $25,834
Disbursed from fund to pay benefits or purchase annuities during the year $23,205
Administration charge made by carrier $0
Transferred to Separate Account $1,120
Other $1,509
Balance at the end of the current year $434,587
Variable Annuity Life Insurance Co. 5
EIN 74-1625348
Industry Code 70238
Contract Number 04082
Contract Year 01/01/2014 — 12/31/2014
Value in General Account at Year End $1,577
Value in Separate Accounts at Year End $22,657
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 Deposit Administration
Balance at the end of the previous year $0
Additions $1,578
Contributions Deposited during the year $0
Dividends and credits $0
Interest credited during the year $21
Transferred from separate account $1,557
Other $0
Total of Balance and Additions $1,578
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 $1,578