2023 Form 5500 filing — Tri State Community Health Center Tax Sheltered Savings 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 20241015160420NAL0058611842001) for Tri State Community Health Center Tax Sheltered Savings Plan, reported by Tri State Community Health Center under EIN 52-1516829 and plan number 001. It reports 230 participants. Attached schedules in the loaded dataset include Schedule H (large plan financials), Schedule C (service provider compensation).
- EFAST2 acknowledgement
- 20241015160420NAL0058611842001
- Filing year
- 2023
- Form type
- 2
- Plan sponsor
- Tri State Community Health Center
- EIN
- 52-1516829
- Plan number
- 001
- Location
- Hancock, MD
- Participants
- 230
- Schedules available
- Schedule H, Schedule C
- Received date
- not reported in the loaded dataset
Reported financial snapshot (2023)
- Total assets (EOY)
- $8,917,342
- Total liabilities (EOY)
- $0
- Net assets (EOY)
- $8,917,342
- Employer contributions
- $377,473
- Participant contributions
- $505,412
- Total income / additions
- $2,451,533
- Benefits paid
- $1,560,884
- Administrative expenses
- $95,696
- Total expenses
- $1,665,048
- Net increase / (decrease)
- $786,485
- Schedule source
- Schedule H
Reported service provider compensation (Schedule C)
| Provider | Service | Direct comp. | Indirect comp. |
|---|---|---|---|
| Nationwide | RECORD KEEPER | $66,170 | $3,917 |
| Cbiz Benefits & Insurance Services | TPA | $27,873 | not reported in the loaded dataset |
| Rbc Capital Markets LLC | INVESTMENT ADVISER | $0 | $23,440 |