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FORM 5500 DATA

Beverly Hospital Matching Savings Plan

Overview

Plan Information

  • Plan Year01/01/2010 — 12/31/2010
  • Date of Plan01/01/2007
  • Net Assets as of 12/31/2010 $5,840,429
  • 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 12/31/2010

  • Active (Eligible) Participants348
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits31
  • Subtotal379
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits0
  • Total379
  • Total number of participants as of 01/01/2010388
  • Number of participants with account balances379
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested1

Expenses

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

Sponsor Information

  • Address309 West Beverly Blvd
  • CityMontebello
  • StateCA
  • Zip90640
  • Telephone(866) 725-3474
  • EIN95-1816005
  • Industry Code622000
  • Named AdministratorMichael Almanzor

Plan Administrator Information

  • Administrator NameBeverly Hospital
  • Address309 West Beverly Blvd
  • CityMontebello
  • StateCA
  • Zip90640
  • Telephone(866) 725-3474
  • Administrator EIN95-1816005

Audit Information

  • Audit StatusAudited
  • AuditorHolthouse Carlin & Van Trigt LLP
  • Auditor EIN95-4345526
  • Audit Opinion Disclaimer
  • Audit TypeLimited Scope Audit

Benefits Provided Under the Plan

Code Benefit Description
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.
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.
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.
2M Code section 403(b)(7) accounts A 403(b)(7) plan is a tax-deferred retirement plan often available to employees of public schools or non-profit organizations.
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.

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 $500,000
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 $1,495,736
Contributions $952,974
Cash Contributions $952,974
Cash from Employers $0
Cash from Participants $915,120
Others (including rollovers) $37,854
Noncash Contributions $0
Total Earnings on Investments $542,762
Total Interest $3,410
Interest-Bearing Cash $0
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $3,390
Interest from Other Investments $20
Total Dividends $119,760
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 $36,489
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 $383,103
Other Income $0
Expenses $366,748
Total Benefit Payments $355,449
Directly to participants or beneficiaries, including direct rollovers $355,449
To insurance carriers for the provision of benefits $0
Other Benefit Payment Fees $0
Corrective Distributions $2,246
Certain deemed distributions of participant loans $0
Interest expense $0
Total Administrative Expenses $9,053
Professional Fees $0
Contract Administrator Fees $0
Investment Advisory and management fees $7,478
Other Administrative Fees $1,575
Net Income $1,128,988
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2010 12/31/2009 Change YOY
Total Assets $5,840,429 $4,711,441 23.96%
Total noninterest-bearing cash $11,202 $0 0.0%
Receivables $130 $0 0.0%
Employer Contributions $0 $0 0.0%
Participant Contributions $0 $0 0.0%
Other Contributions $130 $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 $80,631 $63,718 26.54%
Value of interest in common/collective trusts $0 $0 0.0%
Value of interest in pooled separate accounts $1,291,200 $1,169,990 10.36%
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 $4,438,941 $3,453,428 28.54%
Value of funds held in insurance co. general account $18,325 $24,305 -24.60%
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 $5,840,429 $4,711,441 23.96%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

  • Diversified Investment Advisors

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
Sageview Advisory Group, LLC Consulting (general) Advisor $7,478 $0 $7,478
Diversified Investment Advisors Claims processing, Recordkeeping and information management (computing, tabulating, data processing, etc.), Investment management, Participant loan processing, Participant communication, Direct payment from the plan, Sales loads (front end and deferred), Shareholder servicing fees, Finders' fees/placement fees, Float revenue, Distribution (12b-1) fees, Recordkeeping fees, Account maintenance fees Recordkeeper $1,575 $0 $1,575
National Financial Services Securities brokerage Securities Broker $0 $0 $0
Total $9,053 $0 $9,053

Indirect Compensation

Name Source of Indirect Compensation* Nature of Service Description of Indirect Compensation Indirect Compensation Paid by Plan
Diversified Investment Advisors Davis Claims processing, Recordkeeping and information management (computing, tabulating, data processing, etc.), Investment management, Participant loan processing, Participant communication, Direct payment from the plan, Sales loads (front end and deferred), Shareholder servicing fees, Finders' fees/placement fees, Float revenue, Distribution (12b-1) fees, Recordkeeping fees, Account maintenance fees Revenue Sharing See Attachment To Line 2(H) $0
Diversified Investment Advisors Pimco Claims processing, Recordkeeping and information management (computing, tabulating, data processing, etc.), Investment management, Participant loan processing, Participant communication, Direct payment from the plan, Sales loads (front end and deferred), Shareholder servicing fees, Finders' fees/placement fees, Float revenue, Distribution (12b-1) fees, Recordkeeping fees, Account maintenance fees Revenue Sharing See Attachment To Line 2(H) $0
Diversified Investment Advisors American Funds Claims processing, Recordkeeping and information management (computing, tabulating, data processing, etc.), Investment management, Participant loan processing, Participant communication, Direct payment from the plan, Sales loads (front end and deferred), Shareholder servicing fees, Finders' fees/placement fees, Float revenue, Distribution (12b-1) fees, Recordkeeping fees, Account maintenance fees Revenue Sharing See Attachment To Line 2(H) $0
Diversified Investment Advisors Columbia Claims processing, Recordkeeping and information management (computing, tabulating, data processing, etc.), Investment management, Participant loan processing, Participant communication, Direct payment from the plan, Sales loads (front end and deferred), Shareholder servicing fees, Finders' fees/placement fees, Float revenue, Distribution (12b-1) fees, Recordkeeping fees, Account maintenance fees Revenue Sharing See Attachment To Line 2(H) $0
Diversified Investment Advisors Royce Claims processing, Recordkeeping and information management (computing, tabulating, data processing, etc.), Investment management, Participant loan processing, Participant communication, Direct payment from the plan, Sales loads (front end and deferred), Shareholder servicing fees, Finders' fees/placement fees, Float revenue, Distribution (12b-1) fees, Recordkeeping fees, Account maintenance fees Revenue Sharing See Attachment To Line 2(H) $0
Diversified Investment Advisors Janus Claims processing, Recordkeeping and information management (computing, tabulating, data processing, etc.), Investment management, Participant loan processing, Participant communication, Direct payment from the plan, Sales loads (front end and deferred), Shareholder servicing fees, Finders' fees/placement fees, Float revenue, Distribution (12b-1) fees, Recordkeeping fees, Account maintenance fees Revenue Sharing See Attachment To Line 2(H) $0
Diversified Investment Advisors Morgan Stanley Claims processing, Recordkeeping and information management (computing, tabulating, data processing, etc.), Investment management, Participant loan processing, Participant communication, Direct payment from the plan, Sales loads (front end and deferred), Shareholder servicing fees, Finders' fees/placement fees, Float revenue, Distribution (12b-1) fees, Recordkeeping fees, Account maintenance fees Revenue Sharing See Attachment To Line 2(H) $0
Diversified Investment Advisors Alliance Bernstein Claims processing, Recordkeeping and information management (computing, tabulating, data processing, etc.), Investment management, Participant loan processing, Participant communication, Direct payment from the plan, Sales loads (front end and deferred), Shareholder servicing fees, Finders' fees/placement fees, Float revenue, Distribution (12b-1) fees, Recordkeeping fees, Account maintenance fees Revenue Sharing See Attachment To Line 2(H) $0
Diversified Investment Advisors Invesco Claims processing, Recordkeeping and information management (computing, tabulating, data processing, etc.), Investment management, Participant loan processing, Participant communication, Direct payment from the plan, Sales loads (front end and deferred), Shareholder servicing fees, Finders' fees/placement fees, Float revenue, Distribution (12b-1) fees, Recordkeeping fees, Account maintenance fees Revenue Sharing See Attachment To Line 2(H) $0
Diversified Investment Advisors Allianz Claims processing, Recordkeeping and information management (computing, tabulating, data processing, etc.), Investment management, Participant loan processing, Participant communication, Direct payment from the plan, Sales loads (front end and deferred), Shareholder servicing fees, Finders' fees/placement fees, Float revenue, Distribution (12b-1) fees, Recordkeeping fees, Account maintenance fees Revenue Sharing See Attachment To Line 2(H) $0
National Financial Services Davis Securities brokerage Revenue Sharing See Attachment To Line 2(H) $0
National Financial Services Pimco Securities brokerage Revenue Sharing See Attachment To Line 2(H) $0
National Financial Services American Funds Securities brokerage Revenue Sharing See Attachment To Line 2(H) $0
National Financial Services Columbia Securities brokerage Revenue Sharing See Attachment To Line 2(H) $0
National Financial Services Royce Securities brokerage Revenue Sharing See Attachment To Line 2(H) $0
National Financial Services Janus Securities brokerage Revenue Sharing See Attachment To Line 2(H) $0
National Financial Services Morgan Stanley Securities brokerage Revenue Sharing See Attachment To Line 2(H) $0
National Financial Services Alliance Bernstein Securities brokerage Revenue Sharing See Attachment To Line 2(H) $0
National Financial Services Invesco Securities brokerage Revenue Sharing See Attachment To Line 2(H) $0
National Financial Services Allianz Securities brokerage Revenue Sharing See Attachment To Line 2(H) $0
*As outlined by the Form 5500 Instructions for service providers with indirect compensation.

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
Guaranteed Pooled Fund Transamerica Financial Life Ins Co DFE: Pooled Separate Account $1,291,200
Total $1,291,200

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Transamerica Financial Life Insurance Company 379
EIN 36-6071399
Industry Code 70688
Contract Number TT069231
Contract Year 01/01/2010 — 12/31/2010
Value in General Account at Year End $18,325
Value in Separate Accounts at Year End $1,291,200
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 $24,305
Additions $2,562
Contributions Deposited during the year $0
Dividends and credits $0
Interest credited during the year $20
Transferred from separate account $2,542
Other $0
Total of Balance and Additions $26,867
Deductions $8,542
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 $8,542
Balance at the end of the current year $18,325