401k Plan data: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B plan

CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 401k Plan overview

Plan Name	CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B
Plan identification number	004

CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

WELLSPAN HEALTH has sponsored the creation of one or more 401k plans.

Company Name: WELLSPAN HEALTH

Employer identification number (EIN): 230465970

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
004 2020-01-01
004 2019-01-01
004 2017-01-01 KIMBERLY RZOMP KIMBERLY RZOMP 2018-10-15
004 2016-01-01 KIMBERLY RZOMP KIMBERLY RZOMP 2017-10-12
004 2015-01-01 KIMBERLY RZOMP KIMBERLY RZOMP 2016-10-13
004 2014-01-01 KIMBERLY RZOMP KIMBERLY RZOMP 2015-10-13
004 2013-01-01 KIMBERLY RZOMP KIMBERLY RZOMP 2014-10-13
004 2012-01-01 KIMBERLY RZOMP KIMBERLY RZOMP 2013-10-15
004 2011-01-01 PATRICK O'DONNELL PATRICK O'DONNELL 2012-10-15
004 2010-01-01 PATRICK O'DONNELL PATRICK O'DONNELL 2011-10-17
004 2009-01-01 PATRICK O'DONNELL PATRICK O'DONNELL 2012-01-03
004 2009-01-01 PATRICK W O'DONNELL PATRICK W O'DONNELL 2010-10-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
004	2020-01-01
004	2019-01-01
004	2017-01-01	KIMBERLY RZOMP	KIMBERLY RZOMP	2018-10-15
004	2016-01-01	KIMBERLY RZOMP	KIMBERLY RZOMP	2017-10-12
004	2015-01-01	KIMBERLY RZOMP	KIMBERLY RZOMP	2016-10-13
004	2014-01-01	KIMBERLY RZOMP	KIMBERLY RZOMP	2015-10-13
004	2013-01-01	KIMBERLY RZOMP	KIMBERLY RZOMP	2014-10-13
004	2012-01-01	KIMBERLY RZOMP	KIMBERLY RZOMP	2013-10-15
004	2011-01-01	PATRICK O'DONNELL	PATRICK O'DONNELL	2012-10-15
004	2010-01-01	PATRICK O'DONNELL	PATRICK O'DONNELL	2011-10-17
004	2009-01-01	PATRICK O'DONNELL	PATRICK O'DONNELL	2012-01-03
004	2009-01-01	PATRICK W O'DONNELL	PATRICK W O'DONNELL	2010-10-15

Plan Statistics for CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B

401k plan membership statisitcs for CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B

Measure Date Value
2020: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2020 401k membership
Total participants, beginning-of-year 2020-01-01 956
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 0
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 0
Number of participants with account balances 2020-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 42
2019: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,000
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 787
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 165
Total of all active and inactive participants 2019-01-01 953
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 3
Total participants 2019-01-01 956
Number of participants with account balances 2019-01-01 591
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 16
2017: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2017 401k membership
Total participants, beginning-of-year 2017-01-01 718
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 857
Number of retired or separated participants receiving benefits 2017-01-01 1
Number of other retired or separated participants entitled to future benefits 2017-01-01 125
Total of all active and inactive participants 2017-01-01 983
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 2
Total participants 2017-01-01 985
Number of participants with account balances 2017-01-01 529
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 4
2016: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2016 401k membership
Total participants, beginning-of-year 2016-01-01 868
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 600
Number of retired or separated participants receiving benefits 2016-01-01 2
Number of other retired or separated participants entitled to future benefits 2016-01-01 115
Total of all active and inactive participants 2016-01-01 717
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 1
Total participants 2016-01-01 718
Number of participants with account balances 2016-01-01 497
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 4
2015: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2015 401k membership
Total participants, beginning-of-year 2015-01-01 652
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 752
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 116
Total of all active and inactive participants 2015-01-01 868
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 868
Number of participants with account balances 2015-01-01 475
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 3
2014: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2014 401k membership
Total participants, beginning-of-year 2014-01-01 663
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 548
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 104
Total of all active and inactive participants 2014-01-01 652
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 652
Number of participants with account balances 2014-01-01 447
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 4
2013: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2013 401k membership
Total participants, beginning-of-year 2013-01-01 655
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 569
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 94
Total of all active and inactive participants 2013-01-01 663
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 663
Number of participants with account balances 2013-01-01 436
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 8
2012: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2012 401k membership
Total participants, beginning-of-year 2012-01-01 657
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 573
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 82
Total of all active and inactive participants 2012-01-01 655
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 655
Number of participants with account balances 2012-01-01 407
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 1
2011: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2011 401k membership
Total participants, beginning-of-year 2011-01-01 641
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 588
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 69
Total of all active and inactive participants 2011-01-01 657
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 657
Number of participants with account balances 2011-01-01 392
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2010 401k membership
Total participants, beginning-of-year 2010-01-01 363
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 586
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 55
Total of all active and inactive participants 2010-01-01 641
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 641
Number of participants with account balances 2010-01-01 362
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 1
2009: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2009 401k membership
Total participants, beginning-of-year 2009-01-01 356
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 320
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 43
Total of all active and inactive participants 2009-01-01 363
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 363
Number of participants with account balances 2009-01-01 353
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 4

Measure	Date	Value
2020: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2020 401k membership
Total participants, beginning-of-year	2020-01-01	956
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	0
Number of participants with account balances	2020-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	42
2019: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,000
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	787
Number of retired or separated participants receiving benefits	2019-01-01	1
Number of other retired or separated participants entitled to future benefits	2019-01-01	165
Total of all active and inactive participants	2019-01-01	953
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	3
Total participants	2019-01-01	956
Number of participants with account balances	2019-01-01	591
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	16
2017: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2017 401k membership
Total participants, beginning-of-year	2017-01-01	718
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	857
Number of retired or separated participants receiving benefits	2017-01-01	1
Number of other retired or separated participants entitled to future benefits	2017-01-01	125
Total of all active and inactive participants	2017-01-01	983
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	2
Total participants	2017-01-01	985
Number of participants with account balances	2017-01-01	529
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	4
2016: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2016 401k membership
Total participants, beginning-of-year	2016-01-01	868
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	600
Number of retired or separated participants receiving benefits	2016-01-01	2
Number of other retired or separated participants entitled to future benefits	2016-01-01	115
Total of all active and inactive participants	2016-01-01	717
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	1
Total participants	2016-01-01	718
Number of participants with account balances	2016-01-01	497
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	4
2015: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2015 401k membership
Total participants, beginning-of-year	2015-01-01	652
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	752
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	116
Total of all active and inactive participants	2015-01-01	868
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	868
Number of participants with account balances	2015-01-01	475
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	3
2014: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2014 401k membership
Total participants, beginning-of-year	2014-01-01	663
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	548
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	104
Total of all active and inactive participants	2014-01-01	652
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	652
Number of participants with account balances	2014-01-01	447
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	4
2013: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2013 401k membership
Total participants, beginning-of-year	2013-01-01	655
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	569
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	94
Total of all active and inactive participants	2013-01-01	663
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	663
Number of participants with account balances	2013-01-01	436
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	8
2012: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2012 401k membership
Total participants, beginning-of-year	2012-01-01	657
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	573
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	82
Total of all active and inactive participants	2012-01-01	655
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	655
Number of participants with account balances	2012-01-01	407
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	1
2011: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2011 401k membership
Total participants, beginning-of-year	2011-01-01	641
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	588
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	69
Total of all active and inactive participants	2011-01-01	657
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	657
Number of participants with account balances	2011-01-01	392
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2010 401k membership
Total participants, beginning-of-year	2010-01-01	363
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	586
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	55
Total of all active and inactive participants	2010-01-01	641
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	641
Number of participants with account balances	2010-01-01	362
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	1
2009: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2009 401k membership
Total participants, beginning-of-year	2009-01-01	356
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	320
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	43
Total of all active and inactive participants	2009-01-01	363
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	363
Number of participants with account balances	2009-01-01	353
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	4

Financial Data on CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B

Measure	Date	Value
2020 : CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total transfer of assets from this plan	2020-12-31	$54,943,097
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$9,901,141
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$3,933,556
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$3,902,027
Expenses. Certain deemed distributions of participant loans	2020-12-31	$22,037
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$3,098,515
Value of total assets at end of year	2020-12-31	$0
Value of total assets at beginning of year	2020-12-31	$48,975,512
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$9,492
Total interest from all sources	2020-12-31	$148,739
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$3,022,376
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$3,022,376
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$2,488,108
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$473,359
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$3,309
Other income not declared elsewhere	2020-12-31	$1,521
Administrative expenses (other) incurred	2020-12-31	$9,492
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$5,967,585
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$48,975,512
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$40,680,695
Interest on participant loans	2020-12-31	$21,285
Interest earned on other investments	2020-12-31	$127,454
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$7,821,458
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$3,629,990
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$607,098
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$3,902,027
Did the plan have assets held for investment	2020-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	SMITH ELLIOTT KEARNS & COMPANY
Accountancy firm EIN	2020-12-31	520783935
2019 : CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$11,274,844
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$3,751,115
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$3,737,799
Expenses. Certain deemed distributions of participant loans	2019-12-31	$3,629
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$3,449,507
Value of total assets at end of year	2019-12-31	$48,975,512
Value of total assets at beginning of year	2019-12-31	$41,451,783
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$9,687
Total interest from all sources	2019-12-31	$169,233
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$3,180,872
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$3,180,872
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$2,419,935
Participant contributions at end of year	2019-12-31	$473,359
Participant contributions at beginning of year	2019-12-31	$455,923
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$231,065
Other income not declared elsewhere	2019-12-31	$149
Administrative expenses (other) incurred	2019-12-31	$9,687
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$7,523,729
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$48,975,512
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$41,451,783
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$40,680,695
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$32,028,073
Interest on participant loans	2019-12-31	$22,341
Interest earned on other investments	2019-12-31	$146,892
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$7,821,458
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$8,967,787
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$4,475,083
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$798,507
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$3,737,799
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	SMITH ELLIOTT KEARNS & COMPANY
Accountancy firm EIN	2019-12-31	520783935
2018 : CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$523,858
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$1,649,740
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,613,770
Expenses. Certain deemed distributions of participant loans	2018-12-31	$25,220
Value of total corrective distributions	2018-12-31	$3,784
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$3,017,065
Value of total assets at end of year	2018-12-31	$41,451,783
Value of total assets at beginning of year	2018-12-31	$42,577,665
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$6,966
Total interest from all sources	2018-12-31	$173,740
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$2,403,432
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$2,403,432
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$2,268,471
Participant contributions at end of year	2018-12-31	$455,923
Participant contributions at beginning of year	2018-12-31	$476,486
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$130,006
Other income not declared elsewhere	2018-12-31	$611
Administrative expenses (other) incurred	2018-12-31	$6,966
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-1,125,882
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$41,451,783
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$42,577,665
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$32,028,073
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$33,962,161
Interest on participant loans	2018-12-31	$24,162
Interest earned on other investments	2018-12-31	$149,578
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$8,967,787
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$8,139,018
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-5,070,990
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$618,588
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$1,613,770
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	SMITH ELLIOTT KEARNS & COMPANY
Accountancy firm EIN	2018-12-31	520783935
2017 : CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$9,084,803
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$2,934,905
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$2,924,886
Expenses. Certain deemed distributions of participant loans	2017-12-31	$852
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$3,418,069
Value of total assets at end of year	2017-12-31	$42,577,665
Value of total assets at beginning of year	2017-12-31	$36,427,767
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$9,167
Total interest from all sources	2017-12-31	$224,911
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$1,532,864
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$1,532,864
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$2,322,513
Participant contributions at end of year	2017-12-31	$476,486
Participant contributions at beginning of year	2017-12-31	$344,174
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$509,225
Other income not declared elsewhere	2017-12-31	$23
Administrative expenses (other) incurred	2017-12-31	$9,167
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$6,149,898
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$42,577,665
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$36,427,767
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$33,962,161
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$28,143,695
Interest on participant loans	2017-12-31	$18,491
Interest earned on other investments	2017-12-31	$206,420
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$8,139,018
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$7,939,898
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$3,908,936
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$586,331
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$2,924,886
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	CHARLES L STRAUSBAUGH, CPA, PC
Accountancy firm EIN	2017-12-31	251877259
2016 : CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$5,375,953
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$1,646,995
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$1,644,996
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$3,210,387
Value of total assets at end of year	2016-12-31	$36,427,767
Value of total assets at beginning of year	2016-12-31	$32,698,809
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$1,999
Total interest from all sources	2016-12-31	$237,266
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$1,010,469
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$1,010,469
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$2,212,974
Participant contributions at end of year	2016-12-31	$344,174
Participant contributions at beginning of year	2016-12-31	$342,683
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$438,116
Administrative expenses (other) incurred	2016-12-31	$1,999
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$3,728,958
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$36,427,767
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$32,698,809
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$28,143,695
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$24,980,843
Interest on participant loans	2016-12-31	$17,262
Interest earned on other investments	2016-12-31	$220,004
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$7,939,898
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$7,375,283
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$917,831
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$559,297
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$1,644,996
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	CHARLES L STRAUSBAUGH, CPA, PC
Accountancy firm EIN	2016-12-31	251877259
2015 : CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$2,634,839
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$1,205,838
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$1,204,863
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$2,600,344
Value of total assets at end of year	2015-12-31	$32,698,809
Value of total assets at beginning of year	2015-12-31	$31,269,808
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$975
Total interest from all sources	2015-12-31	$212,191
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$480,927
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$480,927
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$2,010,046
Participant contributions at end of year	2015-12-31	$342,683
Participant contributions at beginning of year	2015-12-31	$459,403
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$100,026
Other income not declared elsewhere	2015-12-31	$606
Administrative expenses (other) incurred	2015-12-31	$975
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$1,429,001
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$32,698,809
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$31,269,808
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$24,980,843
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$24,970,402
Interest on participant loans	2015-12-31	$20,893
Interest earned on other investments	2015-12-31	$191,298
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$7,375,283
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$5,840,003
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-380,987
Net investment gain/loss from pooled separate accounts	2015-12-31	$-278,242
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$490,272
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$1,204,863
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	CHARLES L STRAUSBAUGH, CPA, PC
Accountancy firm EIN	2015-12-31	251877259
2014 : CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$4,029,162
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$724,412
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$722,912
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$2,415,247
Value of total assets at end of year	2014-12-31	$31,269,808
Value of total assets at beginning of year	2014-12-31	$27,965,058
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$1,500
Total interest from all sources	2014-12-31	$186,802
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$1,929,088
Participant contributions at end of year	2014-12-31	$459,403
Participant contributions at beginning of year	2014-12-31	$439,290
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$17,524
Other income not declared elsewhere	2014-12-31	$984
Administrative expenses (other) incurred	2014-12-31	$1,500
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$3,304,750
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$31,269,808
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$27,965,058
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$24,970,402
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$22,427,098
Interest on participant loans	2014-12-31	$23,797
Interest earned on other investments	2014-12-31	$163,005
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$5,840,003
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$5,098,670
Net investment gain/loss from pooled separate accounts	2014-12-31	$1,426,129
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$468,635
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$722,912
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	CHARLES L. STRAUSBAUGH, CPA, PC
Accountancy firm EIN	2014-12-31	251877259
2013 : CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$6,100,305
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$1,595,393
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,594,193
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$2,387,608
Value of total assets at end of year	2013-12-31	$27,965,058
Value of total assets at beginning of year	2013-12-31	$23,460,146
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$1,200
Total interest from all sources	2013-12-31	$169,176
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$1,868,101
Participant contributions at end of year	2013-12-31	$439,290
Participant contributions at beginning of year	2013-12-31	$364,193
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$74,644
Administrative expenses (other) incurred	2013-12-31	$1,200
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$4,504,912
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$27,965,058
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$23,460,146
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$22,427,098
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$18,478,311
Interest on participant loans	2013-12-31	$20,122
Interest earned on other investments	2013-12-31	$149,054
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$5,098,670
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$4,617,642
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$4,674
Net investment gain/loss from pooled separate accounts	2013-12-31	$3,538,847
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$444,863
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,594,193
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	CHARLES L. STRAUSBAUGH, CPA
Accountancy firm EIN	2013-12-31	251877259
2012 : CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$4,775,016
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$1,268,772
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$1,267,497
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$2,304,824
Value of total assets at end of year	2012-12-31	$23,460,146
Value of total assets at beginning of year	2012-12-31	$19,953,902
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$1,275
Total interest from all sources	2012-12-31	$144,976
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$1,847,556
Participant contributions at end of year	2012-12-31	$364,193
Participant contributions at beginning of year	2012-12-31	$292,189
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$6,995
Other income not declared elsewhere	2012-12-31	$1,263
Administrative expenses (other) incurred	2012-12-31	$1,275
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$3,506,244
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$23,460,146
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$19,953,902
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$18,478,311
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$15,812,040
Interest on participant loans	2012-12-31	$19,381
Interest earned on other investments	2012-12-31	$125,595
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$4,617,642
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$3,849,673
Net investment gain/loss from pooled separate accounts	2012-12-31	$2,323,953
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$450,273
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$1,267,497
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	CHARLES L. STRAUSBAUGH, CPA
Accountancy firm EIN	2012-12-31	251877259
2011 : CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$1,843,142
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$290,188
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$288,988
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$2,247,553
Value of total assets at end of year	2011-12-31	$19,953,902
Value of total assets at beginning of year	2011-12-31	$18,400,948
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,200
Total interest from all sources	2011-12-31	$119,630
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$1,641,457
Participant contributions at end of year	2011-12-31	$292,189
Participant contributions at beginning of year	2011-12-31	$280,210
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$184,720
Other income not declared elsewhere	2011-12-31	$-498
Administrative expenses (other) incurred	2011-12-31	$1,200
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$1,552,954
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$19,953,902
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$18,400,948
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$15,812,040
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$15,344,527
Interest on participant loans	2011-12-31	$18,008
Interest earned on other investments	2011-12-31	$101,622
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$3,849,673
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$2,776,211
Net investment gain/loss from pooled separate accounts	2011-12-31	$-523,543
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$421,376
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$288,988
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	CHARLES L. STRAUSBAUGH, CPA
Accountancy firm EIN	2011-12-31	251877259
2010 : CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$4,075,673
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$347,701
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$346,576
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$2,104,879
Value of total assets at end of year	2010-12-31	$18,400,948
Value of total assets at beginning of year	2010-12-31	$14,672,976
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,125
Total interest from all sources	2010-12-31	$89,705
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$1,639,156
Participant contributions at end of year	2010-12-31	$280,210
Participant contributions at beginning of year	2010-12-31	$185,532
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$73,982
Other income not declared elsewhere	2010-12-31	$33
Administrative expenses (other) incurred	2010-12-31	$1,125
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$3,727,972
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$18,400,948
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$14,672,976
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$15,344,527
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$12,184,907
Interest on participant loans	2010-12-31	$14,993
Interest earned on other investments	2010-12-31	$74,712
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$2,776,211
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$2,302,537
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$1,881,056
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$391,741
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$346,576
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	CHARLES L. STRAUSBAUGH, CPA
Accountancy firm EIN	2010-12-31	251877259

Form 5500 Responses for CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B

2020: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	Yes
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2017: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: CHAMBERSBURG HOSPITAL NON-BARGAINING ERISA 403B 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	664055
Policy instance	1
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	664045
Policy instance	1
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	664045
Policy instance	1
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	664045
Policy instance	1
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VFZ159
Policy instance	2
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VFZ159
Policy instance	1
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VFZ159
Policy instance	1
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VFZ159
Policy instance	1
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VFZ159
Policy instance	1
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VFZ159
Policy instance	1

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Company Name:	WELLSPAN HEALTH
Employer identification number (EIN):	230465970
NAIC Classification:	622000
NAIC Description:	Hospitals