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COMMUNITY HOSPITAL RETIREMENT PLAN 401k Plan overview

Plan NameCOMMUNITY HOSPITAL RETIREMENT PLAN
Plan identification number 015

COMMUNITY HOSPITAL RETIREMENT PLAN Benefits

401k Plan TypeDefined Benefit Pension
Plan Features/Benefits
  • Benefits are primarily pay related
  • Cash balance or similar plan - Plan has a "cash balance" formula. For this purpose, a "cash balance" formula is a benefit formula in a defined benefit plan by whatever name (for example, personal account plan, pension equity plan, life cycle plan, cash account plan, etc.) that rather than, or in addition to, expressing the accrued benefit as a life annuity commencing at normal retirement age, defines benefits for each employee in terms more common to a defined contribution plan such as a single sum distribution amount (for example, 10 percent of final average pay times years of service, or the amount of the employee's hypothetical account balance).
  • Frozen Plan - As of the last day of the plan year, the plan provides that no participant will get any new benefit accrual (whether because of service or compensation).

401k Sponsoring company profile

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

Company Name:MERCY HEALTH
Employer identification number (EIN):311161086
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about MERCY HEALTH

Jurisdiction of Incorporation: Arkansas Secretary of State
Incorporation Date:
Company Identification Number: 811013495

More information about MERCY HEALTH

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY HOSPITAL RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0152019-01-01
0152018-01-01
0152017-01-01JOHN ALLISON
0152016-01-01JOHN ALLISON
0152015-01-01DIANNA SMITH
0152014-01-01DIANNA SMITH
0152013-01-01DIANNA SMITH

Plan Statistics for COMMUNITY HOSPITAL RETIREMENT PLAN

401k plan membership statisitcs for COMMUNITY HOSPITAL RETIREMENT PLAN

Measure Date Value
2019: COMMUNITY HOSPITAL RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01746
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: COMMUNITY HOSPITAL RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01778
Total number of active participants reported on line 7a of the Form 55002018-01-01179
Number of retired or separated participants receiving benefits2018-01-0193
Number of other retired or separated participants entitled to future benefits2018-01-01457
Total of all active and inactive participants2018-01-01729
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-0117
Total participants2018-01-01746
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: COMMUNITY HOSPITAL RETIREMENT PLAN 2017 401k membership
Market value of plan assets2017-12-3140,376,770
Acturial value of plan assets2017-12-3141,150,071
Funding target for retired participants and beneficiaries receiving payment2017-12-314,754,456
Number of terminated vested participants2017-12-31583
Fundng target for terminated vested participants2017-12-3117,988,492
Active participant vested funding target2017-12-3111,088,734
Number of active participants2017-12-31184
Total funding liabilities for active participants2017-12-3111,093,569
Total participant count2017-12-31854
Total funding target for all participants2017-12-3133,836,517
Balance at beginning of prior year after applicable adjustments2017-12-310
Prefunding balance at beginning of prior year after applicable adjustments2017-12-317,565,590
Carryover balanced portion elected for use to offset prior years funding requirement2017-12-310
Prefunding balanced used to offset prior years funding requirement2017-12-310
Amount remaining of carryover balance2017-12-310
Amount remaining of prefunding balance2017-12-317,565,590
Present value of excess contributions2017-12-310
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance2017-12-310
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance2017-12-310
Reductions in caryover balances due to elections or deemed elections2017-12-310
Reductions in prefunding balances due to elections or deemed elections2017-12-318,117,122
Balance of carryovers at beginning of current year2017-12-310
Balance of prefunding at beginning of current year2017-12-310
Total employer contributions2017-12-310
Total employee contributions2017-12-310
Contributions allocated toward unpaid minimum require contributions from prior years2017-12-310
Contributions made to avoid restrictions adjusted to valuation date2017-12-310
Contributions allocated toward minimum required contributions for current year adjusted to valuation date2017-12-310
Unpaid minimum required contributions for all prior years2017-12-310
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years2017-12-310
Remaining amount of unpaid minimum required contributions2017-12-310
Minimum required contributions for current year target normal cost2017-12-31150,000
Net shortfall amortization installment of oustanding balance2017-12-310
Waiver amortization installment2017-12-310
Total funding amount beforereflecting carryover/prefunding balances2017-12-310
Additional cash requirement2017-12-310
Contributions allocatedtoward minimum required contributions for current year2017-12-310
Unpaid minimum required contributions for current year2017-12-310
Unpaid minimum required contributions for all years2017-12-310
Total participants, beginning-of-year2017-01-01854
Total number of active participants reported on line 7a of the Form 55002017-01-01189
Number of retired or separated participants receiving benefits2017-01-0194
Number of other retired or separated participants entitled to future benefits2017-01-01486
Total of all active and inactive participants2017-01-01769
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-019
Total participants2017-01-01778
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: COMMUNITY HOSPITAL RETIREMENT PLAN 2016 401k membership
Market value of plan assets2016-12-3140,262,896
Acturial value of plan assets2016-12-3142,868,395
Funding target for retired participants and beneficiaries receiving payment2016-12-314,284,337
Number of terminated vested participants2016-12-31624
Fundng target for terminated vested participants2016-12-3118,445,355
Active participant vested funding target2016-12-3111,353,930
Number of active participants2016-12-31209
Total funding liabilities for active participants2016-12-3111,359,303
Total participant count2016-12-31912
Total funding target for all participants2016-12-3134,088,995
Balance at beginning of prior year after applicable adjustments2016-12-310
Prefunding balance at beginning of prior year after applicable adjustments2016-12-316,606,654
Carryover balanced portion elected for use to offset prior years funding requirement2016-12-310
Prefunding balanced used to offset prior years funding requirement2016-12-310
Amount remaining of carryover balance2016-12-310
Amount remaining of prefunding balance2016-12-316,606,654
Present value of excess contributions2016-12-311,001,489
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance2016-12-311,063,982
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance2016-12-311,063,982
Balance of carryovers at beginning of current year2016-12-310
Balance of prefunding at beginning of current year2016-12-317,565,590
Total employer contributions2016-12-310
Total employee contributions2016-12-310
Contributions allocated toward unpaid minimum require contributions from prior years2016-12-310
Contributions made to avoid restrictions adjusted to valuation date2016-12-310
Contributions allocated toward minimum required contributions for current year adjusted to valuation date2016-12-310
Unpaid minimum required contributions for all prior years2016-12-310
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years2016-12-310
Remaining amount of unpaid minimum required contributions2016-12-310
Minimum required contributions for current year target normal cost2016-12-31245,000
Net shortfall amortization installment of oustanding balance2016-12-310
Waiver amortization installment2016-12-310
Total funding amount beforereflecting carryover/prefunding balances2016-12-310
Additional cash requirement2016-12-310
Contributions allocatedtoward minimum required contributions for current year2016-12-310
Unpaid minimum required contributions for current year2016-12-310
Unpaid minimum required contributions for all years2016-12-310
Total participants, beginning-of-year2016-01-01912
Total number of active participants reported on line 7a of the Form 55002016-01-01184
Number of retired or separated participants receiving benefits2016-01-0184
Number of other retired or separated participants entitled to future benefits2016-01-01570
Total of all active and inactive participants2016-01-01838
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-0116
Total participants2016-01-01854
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: COMMUNITY HOSPITAL RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01969
Total number of active participants reported on line 7a of the Form 55002015-01-01209
Number of retired or separated participants receiving benefits2015-01-0175
Number of other retired or separated participants entitled to future benefits2015-01-01618
Total of all active and inactive participants2015-01-01902
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-0110
Total participants2015-01-01912
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-011
2014: COMMUNITY HOSPITAL RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,031
Total number of active participants reported on line 7a of the Form 55002014-01-01243
Number of retired or separated participants receiving benefits2014-01-0178
Number of other retired or separated participants entitled to future benefits2014-01-01638
Total of all active and inactive participants2014-01-01959
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-0110
Total participants2014-01-01969
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: COMMUNITY HOSPITAL RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,072
Total number of active participants reported on line 7a of the Form 55002013-01-01301
Number of retired or separated participants receiving benefits2013-01-0184
Number of other retired or separated participants entitled to future benefits2013-01-01635
Total of all active and inactive participants2013-01-011,020
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-0111
Total participants2013-01-011,031
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010

Financial Data on COMMUNITY HOSPITAL RETIREMENT PLAN

Measure Date Value
2019 : COMMUNITY HOSPITAL RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$1,160,794
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$1,160,794
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$299,600
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$299,600
Total income from all sources (including contributions)2019-12-31$692,432
Total income from all sources (including contributions)2019-12-31$692,432
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$35,155,838
Total of all expenses incurred2019-12-31$35,155,838
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$35,120,904
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$35,120,904
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$0
Value of total assets at end of year2019-12-31$2,478,713
Value of total assets at end of year2019-12-31$2,478,713
Value of total assets at beginning of year2019-12-31$36,080,925
Value of total assets at beginning of year2019-12-31$36,080,925
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$34,934
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$34,934
Total interest from all sources2019-12-31$0
Total interest from all sources2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31Yes
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2019-12-31$0
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2019-12-31$0
Administrative expenses professional fees incurred2019-12-31$34,934
Administrative expenses professional fees incurred2019-12-31$34,934
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$5,000,000
Value of fidelity bond cover2019-12-31$5,000,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-12-31$18,849,230
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-12-31$18,849,230
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$787
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$787
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$61,600
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$61,600
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$1,137,386
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$1,137,386
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Other income not declared elsewhere2019-12-31$-115
Other income not declared elsewhere2019-12-31$-115
Liabilities. Value of operating payables at end of year2019-12-31$23,408
Liabilities. Value of operating payables at end of year2019-12-31$23,408
Liabilities. Value of operating payables at beginning of year2019-12-31$299,600
Liabilities. Value of operating payables at beginning of year2019-12-31$299,600
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$-34,463,406
Value of net income/loss2019-12-31$-34,463,406
Value of net assets at end of year (total assets less liabilities)2019-12-31$1,317,919
Value of net assets at end of year (total assets less liabilities)2019-12-31$1,317,919
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$35,781,325
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$35,781,325
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in master investment trust accounts at end of year2019-12-31$2,477,926
Value of interest in master investment trust accounts at end of year2019-12-31$2,477,926
Value of interest in master investment trust accounts at beginning of year2019-12-31$36,019,210
Value of interest in master investment trust accounts at beginning of year2019-12-31$36,019,210
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$115
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$115
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$16,271,674
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$16,271,674
Did the plan have assets held for investment2019-12-31No
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31KPMG
Accountancy firm name2019-12-31KPMG
Accountancy firm EIN2019-12-31135565207
Accountancy firm EIN2019-12-31135565207
2018 : COMMUNITY HOSPITAL RETIREMENT PLAN 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-12-31$-35,879
Total unrealized appreciation/depreciation of assets2018-12-31$-35,879
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$299,600
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$-1,653,861
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$4,860,463
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$4,367,902
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$0
Value of total assets at end of year2018-12-31$36,080,925
Value of total assets at beginning of year2018-12-31$42,295,649
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$492,561
Total interest from all sources2018-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2018-12-31$0
Administrative expenses professional fees incurred2018-12-31$130,601
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$5,000,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$61,600
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$0
Other income not declared elsewhere2018-12-31$-92,496
Administrative expenses (other) incurred2018-12-31$299,600
Liabilities. Value of operating payables at end of year2018-12-31$299,600
Liabilities. Value of operating payables at beginning of year2018-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-6,514,324
Value of net assets at end of year (total assets less liabilities)2018-12-31$35,781,325
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$42,295,649
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$27,413
Value of interest in master investment trust accounts at end of year2018-12-31$36,019,210
Value of interest in master investment trust accounts at beginning of year2018-12-31$42,167,159
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$115
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$128,490
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$0
Employer contributions (assets) at end of year2018-12-31$0
Employer contributions (assets) at beginning of year2018-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$4,367,902
Contract administrator fees2018-12-31$34,947
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31KPMG
Accountancy firm EIN2018-12-31135565207
2017 : COMMUNITY HOSPITAL RETIREMENT PLAN 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-12-31$4,734
Total unrealized appreciation/depreciation of assets2017-12-31$4,734
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$5,109,444
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$3,317,804
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$3,166,090
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$0
Value of total assets at end of year2017-12-31$42,295,649
Value of total assets at beginning of year2017-12-31$40,504,009
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$151,714
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2017-12-31$0
Administrative expenses professional fees incurred2017-12-31$151,714
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$5,000,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$1,791,640
Value of net assets at end of year (total assets less liabilities)2017-12-31$42,295,649
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$40,504,009
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in master investment trust accounts at end of year2017-12-31$42,167,159
Value of interest in master investment trust accounts at beginning of year2017-12-31$40,376,770
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$128,490
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$127,239
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$0
Employer contributions (assets) at end of year2017-12-31$0
Employer contributions (assets) at beginning of year2017-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$3,166,090
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31ERNST & YOUNG
Accountancy firm EIN2017-12-31346565596
2016 : COMMUNITY HOSPITAL RETIREMENT PLAN 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-12-31$4,658
Total unrealized appreciation/depreciation of assets2016-12-31$4,658
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$2,843,971
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$2,779,655
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$2,574,432
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$0
Value of total assets at end of year2016-12-31$40,504,009
Value of total assets at beginning of year2016-12-31$40,439,693
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$205,223
Total interest from all sources2016-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Administrative expenses professional fees incurred2016-12-31$205,223
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$5,000,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$64,316
Value of net assets at end of year (total assets less liabilities)2016-12-31$40,504,009
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$40,439,693
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in master investment trust accounts at end of year2016-12-31$40,376,770
Value of interest in master investment trust accounts at beginning of year2016-12-31$39,198,914
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$127,239
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$130,779
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$0
Employer contributions (assets) at end of year2016-12-31$0
Employer contributions (assets) at beginning of year2016-12-31$1,110,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$2,574,432
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31ERNST & YOUNG
Accountancy firm EIN2016-12-31346565596
2015 : COMMUNITY HOSPITAL RETIREMENT PLAN 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-12-31$5,137
Total unrealized appreciation/depreciation of assets2015-12-31$5,137
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$459,303
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$2,424,214
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$2,252,731
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,110,000
Value of total assets at end of year2015-12-31$40,439,693
Value of total assets at beginning of year2015-12-31$42,404,604
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$171,483
Total interest from all sources2015-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$171,483
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$5,000,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-1,964,911
Value of net assets at end of year (total assets less liabilities)2015-12-31$40,439,693
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$42,404,604
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in master investment trust accounts at end of year2015-12-31$39,198,914
Value of interest in master investment trust accounts at beginning of year2015-12-31$42,226,791
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$130,779
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$177,813
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$1,110,000
Employer contributions (assets) at end of year2015-12-31$1,110,000
Employer contributions (assets) at beginning of year2015-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$2,252,731
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31ERNST & YOUNG
Accountancy firm EIN2015-12-31346565596
2014 : COMMUNITY HOSPITAL RETIREMENT PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$7,456
Total unrealized appreciation/depreciation of assets2014-12-31$7,456
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$1,611,026
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$3,408,625
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$3,278,224
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$0
Value of total assets at end of year2014-12-31$42,404,604
Value of total assets at beginning of year2014-12-31$44,202,203
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$130,401
Total interest from all sources2014-12-31$0
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 year2014-12-31No
Administrative expenses professional fees incurred2014-12-31$119,633
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$5,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$0
Other income not declared elsewhere2014-12-31$81,208
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-1,797,599
Value of net assets at end of year (total assets less liabilities)2014-12-31$42,404,604
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$44,202,203
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Investment advisory and management fees2014-12-31$10,768
Value of interest in master investment trust accounts at end of year2014-12-31$42,226,791
Value of interest in master investment trust accounts at beginning of year2014-12-31$34,437,411
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$177,813
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$229,792
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$0
Employer contributions (assets) at end of year2014-12-31$0
Employer contributions (assets) at beginning of year2014-12-31$9,535,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$3,278,224
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31ERNST & YOUNG
Accountancy firm EIN2014-12-31346565596
2013 : COMMUNITY HOSPITAL RETIREMENT PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$8,409
Total unrealized appreciation/depreciation of assets2013-12-31$8,409
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$140,013
Total income from all sources (including contributions)2013-12-31$14,644,346
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$3,467,762
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$3,319,344
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$11,620,000
Value of total assets at end of year2013-12-31$44,202,203
Value of total assets at beginning of year2013-12-31$33,165,632
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$148,418
Total interest from all sources2013-12-31$0
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 year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$113,326
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$5,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$140,013
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$11,176,584
Value of net assets at end of year (total assets less liabilities)2013-12-31$44,202,203
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$33,025,619
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Investment advisory and management fees2013-12-31$35,092
Value of interest in master investment trust accounts at end of year2013-12-31$34,437,411
Value of interest in master investment trust accounts at beginning of year2013-12-31$30,642,107
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$229,792
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$228,525
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$11,620,000
Employer contributions (assets) at end of year2013-12-31$9,535,000
Employer contributions (assets) at beginning of year2013-12-31$2,295,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$3,319,344
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31ERNST & YOUNG
Accountancy firm EIN2013-12-31346565596

Form 5500 Responses for COMMUNITY HOSPITAL RETIREMENT PLAN

2019: COMMUNITY HOSPITAL RETIREMENT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: COMMUNITY HOSPITAL RETIREMENT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: COMMUNITY HOSPITAL RETIREMENT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: COMMUNITY HOSPITAL RETIREMENT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: COMMUNITY HOSPITAL RETIREMENT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: COMMUNITY HOSPITAL RETIREMENT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: COMMUNITY HOSPITAL RETIREMENT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB00343
Policy instance 1
Insurance contract or identification numberB00343
Number of Individuals Covered2
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP ANNUITY CONTRACT
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB00343
Policy instance 1
Insurance contract or identification numberB00343
Number of Individuals Covered38
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP ANNUITY CONTRACT
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB00343
Policy instance 2
Insurance contract or identification numberB00343
Number of Individuals Covered2
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP ANNUITY CONTRACT
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB00343
Policy instance 1
Insurance contract or identification numberB00343
Number of Individuals Covered43
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP ANNUITY CONTRACT
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB00343
Policy instance 2
Insurance contract or identification numberB00343
Number of Individuals Covered2
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP ANNUITY CONTRACT
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB00343
Policy instance 1
Insurance contract or identification numberB00343
Number of Individuals Covered2
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP ANNUITY CONTRACT
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB00343
Policy instance 1
Insurance contract or identification numberB00343
Number of Individuals Covered2
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP ANNUITY CONTRACT

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