2023 Form 5500 filing — Providence Medical Center Tax Deferred Annuity Plan
Plain-English filing summary
According to public Form 5500 filings published through the U.S. Department of Labor (DOL) Employee Benefits Security Administration (EBSA) via the EFAST2 system, this is the 2023 Form 5500 filing (EFAST2 acknowledgement 20241014125216NAL0013306099001) for Providence Medical Center Tax Deferred Annuity Plan, reported by Providence Medical Center under EIN 47-0566524 and plan number 005. It reports 240 participants. Attached schedules in the loaded dataset include Schedule H (large plan financials), Schedule C (service provider compensation).
- EFAST2 acknowledgement
- 20241014125216NAL0013306099001
- Filing year
- 2023
- Form type
- 2
- Plan sponsor
- Providence Medical Center
- EIN
- 47-0566524
- Plan number
- 005
- Location
- Wayne, NE
- Participants
- 240
- Schedules available
- Schedule H, Schedule C
- Received date
- not reported in the loaded dataset
Reported financial snapshot (2023)
- Total assets (EOY)
- $15,320,499
- Total liabilities (EOY)
- $0
- Net assets (EOY)
- $15,320,499
- Employer contributions
- $369,240
- Participant contributions
- $852,990
- Total income / additions
- $3,649,727
- Benefits paid
- $1,087,571
- Administrative expenses
- $52,138
- Total expenses
- $1,139,709
- Net increase / (decrease)
- $2,510,018
- Schedule source
- Schedule H
Reported service provider compensation (Schedule C)
| Provider | Service | Direct comp. | Indirect comp. |
|---|---|---|---|
| Principal Life Insurance Company | CONTRACT ADMINISTRATOR | $52,138 | $0 |
| Ameriprise Financial Services Inc | INVESTMENT ADVISORY | $0 | $20,916 |