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FORM 5500 DATA

Intercare Community Health Network 401k Retirement Plan

Overview

Plan Information

  • Plan Year04/01/2016 — 03/31/2017
  • Date of Plan06/01/2004
  • Net Assets as of 03/31/2017 $8,039,216
  • Plan Number1
  • 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 03/31/2017

  • Active (Eligible) Participants424
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits38
  • Subtotal462
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits0
  • Total462
  • Total number of participants as of 04/01/2016430
  • Number of participants with account balances295
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested5

Expenses

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

Sponsor Information

  • Address50 Industrial Park Rd
  • CityBangor
  • StateMI
  • Zip49013-1246
  • Telephone(269) 427-7937
  • EIN38-2009364
  • Industry Code621498
  • Named AdministratorAmy Mulhall
  • Named Plan SponsorAmy Mulhall

Audit Information

  • Audit StatusAudited
  • AuditorYeo & Yeo
  • Auditor EIN38-2706146
  • 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.
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.
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.

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 $2,001,367
Contributions $1,220,983
Cash Contributions $1,220,983
Cash from Employers $209,000
Cash from Participants $912,541
Others (including rollovers) $99,442
Noncash Contributions $0
Total Earnings on Investments $780,748
Total Interest $4,334
Interest-Bearing Cash $0
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $4,107
Interest from Other Investments $227
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 $0
Net investment gain (loss) from pooled separate accounts $776,414
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 $-364
Expenses $255,818
Total Benefit Payments $252,666
Directly to participants or beneficiaries, including direct rollovers $252,666
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 $3,152
Professional Fees $0
Contract Administrator Fees $3,152
Investment Advisory and management fees $0
Other Administrative Fees $0
Net Income $1,745,549
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

03/31/2017 03/31/2016 Change YOY
Total Assets $8,039,216 $6,293,667 27.74%
Total noninterest-bearing cash $0 $0 0.0%
Receivables $48,973 $37,591 30.28%
Employer Contributions $8,750 $7,107 23.12%
Participant Contributions $40,223 $30,484 31.95%
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 $85,947 $87,572 -1.86%
Value of interest in common/collective trusts $0 $0 0.0%
Value of interest in pooled separate accounts $7,834,031 $6,111,053 28.19%
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 $70,265 $57,451 22.30%
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 $8,039,216 $6,293,667 27.74%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

  • Principal Life Insurance 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
Principal Life Insurance Company Contract Administrator, Participant loan processing, Direct payment from the plan, Recordkeeping fees Contract Administrator $3,152 $0 $3,152
Total $3,152 $0 $3,152

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
Prin Lifetime 2040 Sep Acct-R1 Principal Life Insurance Company DFE: Pooled Separate Account $778,292
Prin Lifetime 2030 Sep Acct-R1 Principal Life Insurance Company DFE: Pooled Separate Account $712,222
Prin Lifetime 2020 Sep Acct-R1 Principal Life Insurance Company DFE: Pooled Separate Account $658,680
Prin Largecap Value III Sa-R1 Principal Life Insurance Company DFE: Pooled Separate Account $621,694
Prin Lgcap S&P 500 Index Sa-R1 Principal Life Insurance Company DFE: Pooled Separate Account $602,451
Prin Diversified Intl Sa-R1 Principal Life Insurance Company DFE: Pooled Separate Account $584,012
Prin U.S. Property Sep Acct-R1 Principal Life Insurance Company DFE: Pooled Separate Account $447,402
Prin Midcap Value I Sa-R1 Principal Life Insurance Company DFE: Pooled Separate Account $441,428
Prin Core Plus Bond Sep Act-R1 Principal Life Insurance Company DFE: Pooled Separate Account $416,794
Prin Midcap Growth III Sa-R1 Principal Life Insurance Company DFE: Pooled Separate Account $315,598
Prin Smallcap Value II Sa-R1 Principal Life Insurance Company DFE: Pooled Separate Account $308,847
Prin Largecap Growth I Sa-R1 Principal Life Insurance Company DFE: Pooled Separate Account $290,197
Prin Lifetime 2025 Sep Acct-R1 Principal Life Insurance Company DFE: Pooled Separate Account $287,245
Prin Smcap S&P 600 Index Sa-R1 Principal Life Insurance Company DFE: Pooled Separate Account $242,972
Prin Lifetime 2050 Sep Acct-R1 Principal Life Insurance Company DFE: Pooled Separate Account $187,344
Prin Lifetime 2045 Sep Acct-R1 Principal Life Insurance Company DFE: Pooled Separate Account $181,884
Prin Smallcap Growth I Sa-R1 Principal Life Insurance Company DFE: Pooled Separate Account $167,027
Prin Lifetime 2055 Sep Acct-R1 Principal Life Insurance Company DFE: Pooled Separate Account $146,492
Prin Lifetime 2035 Sep Acct-R1 Principal Life Insurance Company DFE: Pooled Separate Account $126,123
Prin Liquid Assets Sep Acct-R1 Principal Life Insurance Company DFE: Pooled Separate Account $105,797
Prin Lifetime 2015 Sep Acct-R1 Principal Life Insurance Company DFE: Pooled Separate Account $69,011
Prin Lifetime 2010 Sep Acct-R1 Principal Life Insurance Company DFE: Pooled Separate Account $62,153
Prin Lifetime Strat Inc Sa-R1 Principal Life Insurance Company DFE: Pooled Separate Account $52,503
Prin Midcap S&P 400 Idx Sa-R1 Principal Life Insurance Company DFE: Pooled Separate Account $24,186
Prin Lifetime 2060 Sep Acct-R1 Principal Life Insurance Company DFE: Pooled Separate Account $3,677
Total $7,834,031

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Principal Life Insurance Company 462
EIN 42-0127290
Industry Code 61271
Contract Number 709875
Contract Year 04/01/2016 — 03/31/2017
Value in General Account at Year End $70,265
Value in Separate Accounts at Year End $7,834,031
Insurance Fees and Commissions $16,736
Persons Receiving Commissions and Fees
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
Acrisure LLC 5664 Prairie Creek Dr SE Caledonia, MI 49316 -8081 Insurance Agent or Broker $14,412 $0
Signator Insurance Agency Inc 197 Clarendon St Ste C8 Boston, MA 02116 -5010 Insurance Agent or Broker $2,324 $0
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 FLEXIBLE INVESTMENT ANNUITY
Balance at the end of the previous year $58,082
Additions $13,192
Contributions Deposited during the year $12,387
Dividends and credits $0
Interest credited during the year $227
Transferred from separate account $0
Other $578
Total of Balance and Additions $71,274
Deductions $15
Disbursed from fund to pay benefits or purchase annuities during the year $0
Administration charge made by carrier $15
Transferred to Separate Account $0
Other $0
Balance at the end of the current year $71,259