401k Plan data: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN plan

COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 401k Plan overview

Plan Name	COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN
Plan identification number	001

COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

COMMUNITY HOSPITALS AND WELLNESS CENTERS has sponsored the creation of one or more 401k plans.

Company Name: COMMUNITY HOSPITALS AND WELLNESS CENTERS

Employer identification number (EIN): 341048666

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about COMMUNITY HOSPITALS AND WELLNESS CENTERS

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1969-05-16

Company Identification Number: 384200

Legal Registered Office Address: 433 WEST HIGH ST
-
BRYAN
United States of America (USA)
43506

More information about COMMUNITY HOSPITALS AND WELLNESS CENTERS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01 ANGELIA FOSTER
001 2017-01-01 ANGELIA FOSTER
001 2016-01-01 CHAD TINKEL
001 2015-01-01 CHAD TINKEL
001 2014-01-01 CHAD TINKEL
001 2013-01-01 CHAD TINKEL
001 2012-01-01 CHAD TINKEL
001 2011-01-01 CHAD TINKEL
001 2009-01-01 CHAD TINKEL
001 2009-01-01 MICHAEL W KRUCKER CHAD D. TINKEL 2010-10-15

Plan Statistics for COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN

401k plan membership statisitcs for COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN

Measure Date Value
2022: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 810
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 744
Number of retired or separated participants receiving benefits 2022-01-01 10
Number of other retired or separated participants entitled to future benefits 2022-01-01 39
Total of all active and inactive participants 2022-01-01 793
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 793
Number of participants with account balances 2022-01-01 793
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 812
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 766
Number of retired or separated participants receiving benefits 2021-01-01 10
Number of other retired or separated participants entitled to future benefits 2021-01-01 33
Total of all active and inactive participants 2021-01-01 809
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 1
Total participants 2021-01-01 810
Number of participants with account balances 2021-01-01 809
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 815
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 729
Number of retired or separated participants receiving benefits 2020-01-01 51
Number of other retired or separated participants entitled to future benefits 2020-01-01 32
Total of all active and inactive participants 2020-01-01 812
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 812
Number of participants with account balances 2020-01-01 812
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 846
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 729
Number of retired or separated participants receiving benefits 2019-01-01 45
Number of other retired or separated participants entitled to future benefits 2019-01-01 41
Total of all active and inactive participants 2019-01-01 815
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 815
Number of participants with account balances 2019-01-01 815
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 837
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 769
Number of retired or separated participants receiving benefits 2018-01-01 44
Number of other retired or separated participants entitled to future benefits 2018-01-01 32
Total of all active and inactive participants 2018-01-01 845
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 1
Total participants 2018-01-01 846
Number of participants with account balances 2018-01-01 846
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 819
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 770
Number of retired or separated participants receiving benefits 2017-01-01 33
Number of other retired or separated participants entitled to future benefits 2017-01-01 33
Total of all active and inactive participants 2017-01-01 836
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 1
Total participants 2017-01-01 837
Number of participants with account balances 2017-01-01 833
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 766
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 744
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 75
Total of all active and inactive participants 2016-01-01 819
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 819
Number of participants with account balances 2016-01-01 819
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 768
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 687
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 79
Total of all active and inactive participants 2015-01-01 766
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 766
Number of participants with account balances 2015-01-01 766
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 729
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 694
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 74
Total of all active and inactive participants 2014-01-01 768
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 768
Number of participants with account balances 2014-01-01 768
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 729
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 655
Number of retired or separated participants receiving benefits 2013-01-01 19
Number of other retired or separated participants entitled to future benefits 2013-01-01 55
Total of all active and inactive participants 2013-01-01 729
Total participants 2013-01-01 729
Number of participants with account balances 2013-01-01 710
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 736
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 729
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 0
Total of all active and inactive participants 2012-01-01 729
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 729
Number of participants with account balances 2012-01-01 471
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 786
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 736
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 0
Total of all active and inactive participants 2011-01-01 736
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 736
Number of participants with account balances 2011-01-01 246
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 833
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 710
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 55
Total of all active and inactive participants 2009-01-01 765
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 765
Number of participants with account balances 2009-01-01 224
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2022: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	810
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	744
Number of retired or separated participants receiving benefits	2022-01-01	10
Number of other retired or separated participants entitled to future benefits	2022-01-01	39
Total of all active and inactive participants	2022-01-01	793
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	793
Number of participants with account balances	2022-01-01	793
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	812
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	766
Number of retired or separated participants receiving benefits	2021-01-01	10
Number of other retired or separated participants entitled to future benefits	2021-01-01	33
Total of all active and inactive participants	2021-01-01	809
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	1
Total participants	2021-01-01	810
Number of participants with account balances	2021-01-01	809
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	815
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	729
Number of retired or separated participants receiving benefits	2020-01-01	51
Number of other retired or separated participants entitled to future benefits	2020-01-01	32
Total of all active and inactive participants	2020-01-01	812
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	812
Number of participants with account balances	2020-01-01	812
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	846
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	729
Number of retired or separated participants receiving benefits	2019-01-01	45
Number of other retired or separated participants entitled to future benefits	2019-01-01	41
Total of all active and inactive participants	2019-01-01	815
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	815
Number of participants with account balances	2019-01-01	815
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	837
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	769
Number of retired or separated participants receiving benefits	2018-01-01	44
Number of other retired or separated participants entitled to future benefits	2018-01-01	32
Total of all active and inactive participants	2018-01-01	845
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	1
Total participants	2018-01-01	846
Number of participants with account balances	2018-01-01	846
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	819
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	770
Number of retired or separated participants receiving benefits	2017-01-01	33
Number of other retired or separated participants entitled to future benefits	2017-01-01	33
Total of all active and inactive participants	2017-01-01	836
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	1
Total participants	2017-01-01	837
Number of participants with account balances	2017-01-01	833
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	766
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	744
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	75
Total of all active and inactive participants	2016-01-01	819
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	819
Number of participants with account balances	2016-01-01	819
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	768
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	687
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	79
Total of all active and inactive participants	2015-01-01	766
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	766
Number of participants with account balances	2015-01-01	766
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	729
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	694
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	74
Total of all active and inactive participants	2014-01-01	768
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	768
Number of participants with account balances	2014-01-01	768
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	729
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	655
Number of retired or separated participants receiving benefits	2013-01-01	19
Number of other retired or separated participants entitled to future benefits	2013-01-01	55
Total of all active and inactive participants	2013-01-01	729
Total participants	2013-01-01	729
Number of participants with account balances	2013-01-01	710
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	736
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	729
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	0
Total of all active and inactive participants	2012-01-01	729
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	729
Number of participants with account balances	2012-01-01	471
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	786
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	736
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	0
Total of all active and inactive participants	2011-01-01	736
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	736
Number of participants with account balances	2011-01-01	246
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	833
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	710
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	55
Total of all active and inactive participants	2009-01-01	765
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	765
Number of participants with account balances	2009-01-01	224
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN

Measure	Date	Value
2022 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$1,898,243
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$1,167,246
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$1,156,930
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$4,308,564
Value of total assets at end of year	2022-12-31	$29,327,062
Value of total assets at beginning of year	2022-12-31	$28,596,065
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$10,316
Total interest from all sources	2022-12-31	$516,916
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$3,884
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$3,884
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$2,140,005
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$31,265
Total non interest bearing cash at end of year	2022-12-31	$11,280
Total non interest bearing cash at beginning of year	2022-12-31	$7,083
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$730,997
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$29,327,062
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$28,596,065
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$13,840,562
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$15,025,768
Interest earned on other investments	2022-12-31	$516,916
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$13,942,912
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$12,436,851
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-214,010
Net investment gain/loss from pooled separate accounts	2022-12-31	$-2,717,111
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$2,137,294
Employer contributions (assets) at end of year	2022-12-31	$1,532,308
Employer contributions (assets) at beginning of year	2022-12-31	$1,126,363
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$1,156,930
Contract administrator fees	2022-12-31	$10,316
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2022-12-31	381357951
2021 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$4,932,444
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$2,662,540
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$2,655,401
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$2,428,219
Value of total assets at end of year	2021-12-31	$28,596,065
Value of total assets at beginning of year	2021-12-31	$26,326,161
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$7,139
Total interest from all sources	2021-12-31	$506,037
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$16,128
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$16,128
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$1,286,283
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$15,573
Total non interest bearing cash at end of year	2021-12-31	$7,083
Total non interest bearing cash at beginning of year	2021-12-31	$5,729
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$2,269,904
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$28,596,065
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$26,326,161
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$15,025,768
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$12,633,359
Interest earned on other investments	2021-12-31	$506,037
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$12,436,851
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$12,452,125
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$151,795
Net investment gain/loss from pooled separate accounts	2021-12-31	$1,830,265
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$1,126,363
Employer contributions (assets) at end of year	2021-12-31	$1,126,363
Employer contributions (assets) at beginning of year	2021-12-31	$1,234,948
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$2,655,401
Contract administrator fees	2021-12-31	$7,139
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2021-12-31	381357951
2020 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
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	$5,031,020
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$981,900
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$961,898
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$2,539,512
Value of total assets at end of year	2020-12-31	$26,326,161
Value of total assets at beginning of year	2020-12-31	$22,277,041
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$20,002
Total interest from all sources	2020-12-31	$466,458
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$7,780
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	$7,780
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$1,198,353
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$106,211
Total non interest bearing cash at end of year	2020-12-31	$5,729
Total non interest bearing cash at beginning of year	2020-12-31	$6,327
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	$4,049,120
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$26,326,161
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$22,277,041
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	$12,633,359
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$9,814,510
Interest earned on other investments	2020-12-31	$466,458
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$12,452,125
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$11,216,050
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$201,953
Net investment gain/loss from pooled separate accounts	2020-12-31	$1,815,317
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	No
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	$1,234,948
Employer contributions (assets) at end of year	2020-12-31	$1,234,948
Employer contributions (assets) at beginning of year	2020-12-31	$1,240,154
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$961,898
Contract administrator fees	2020-12-31	$20,002
Did the plan have assets held for investment	2020-12-31	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	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	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2020-12-31	381357951
2019 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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	$4,578,706
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$1,376,736
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$1,354,360
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$2,269,010
Value of total assets at end of year	2019-12-31	$22,277,041
Value of total assets at beginning of year	2019-12-31	$19,075,071
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$22,376
Total interest from all sources	2019-12-31	$187
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$10,716
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	$10,716
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$1,028,856
Total non interest bearing cash at end of year	2019-12-31	$6,327
Total non interest bearing cash at beginning of year	2019-12-31	$10,389
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	$3,201,970
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$22,277,041
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$19,075,071
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	$9,814,510
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$8,053,095
Interest earned on other investments	2019-12-31	$187
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$11,216,050
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$10,702,891
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$276,045
Net investment gain/loss from pooled separate accounts	2019-12-31	$2,022,748
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	No
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	$1,240,154
Employer contributions (assets) at end of year	2019-12-31	$1,240,154
Employer contributions (assets) at beginning of year	2019-12-31	$308,696
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,354,360
Contract administrator fees	2019-12-31	$22,376
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	PLANTE & MORAN, PLLC
Accountancy firm EIN	2019-12-31	381357951
2018 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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	$1,326,392
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$611,635
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$599,082
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$1,373,518
Value of total assets at end of year	2018-12-31	$19,075,071
Value of total assets at beginning of year	2018-12-31	$18,360,314
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$12,553
Total interest from all sources	2018-12-31	$17,398
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$20,093
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	$20,093
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$1,007,090
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$57,732
Total non interest bearing cash at end of year	2018-12-31	$10,389
Total non interest bearing cash at beginning of year	2018-12-31	$8,688
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	$714,757
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$19,075,071
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$18,360,314
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	$8,053,095
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$7,921,217
Interest earned on other investments	2018-12-31	$17,398
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$10,702,891
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$9,819,488
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-116,792
Net investment gain/loss from pooled separate accounts	2018-12-31	$32,175
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	No
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	$308,696
Employer contributions (assets) at end of year	2018-12-31	$308,696
Employer contributions (assets) at beginning of year	2018-12-31	$610,921
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$599,082
Contract administrator fees	2018-12-31	$12,553
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	PLANTE & MORAN, PLLC
Accountancy firm EIN	2018-12-31	381357951
2017 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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	$3,145,973
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$1,009,265
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$993,727
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,672,872
Value of total assets at end of year	2017-12-31	$18,360,314
Value of total assets at beginning of year	2017-12-31	$16,223,606
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$15,538
Total interest from all sources	2017-12-31	$370,059
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$21,179
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	$21,179
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$923,333
Participant contributions at end of year	2017-12-31	$0
Participant contributions at beginning of year	2017-12-31	$7,230
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$138,618
Total non interest bearing cash at end of year	2017-12-31	$8,688
Total non interest bearing cash at beginning of year	2017-12-31	$10,722
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	$2,136,708
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$18,360,314
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$16,223,606
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	$7,921,217
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$6,615,193
Interest earned on other investments	2017-12-31	$370,059
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$9,819,488
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$8,713,504
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$227,724
Net investment gain/loss from pooled separate accounts	2017-12-31	$854,139
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	$610,921
Employer contributions (assets) at end of year	2017-12-31	$610,921
Employer contributions (assets) at beginning of year	2017-12-31	$876,957
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$993,727
Contract administrator fees	2017-12-31	$15,538
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	PLANTE & MORAN, PLLC
Accountancy firm EIN	2017-12-31	381357951
2016 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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	$2,972,858
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$914,347
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$909,194
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$2,158,761
Value of total assets at end of year	2016-12-31	$16,223,606
Value of total assets at beginning of year	2016-12-31	$14,165,095
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$5,153
Total interest from all sources	2016-12-31	$309,450
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$36,386
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	$36,386
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$905,373
Participant contributions at end of year	2016-12-31	$7,230
Participant contributions at beginning of year	2016-12-31	$7,103
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$376,431
Total non interest bearing cash at end of year	2016-12-31	$10,722
Total non interest bearing cash at beginning of year	2016-12-31	$4,542
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	$2,058,511
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$16,223,606
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$14,165,095
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	$6,615,193
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$6,362,905
Interest on participant loans	2016-12-31	$127
Interest earned on other investments	2016-12-31	$309,323
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$8,713,504
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$6,949,498
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$132,495
Net investment gain/loss from pooled separate accounts	2016-12-31	$335,766
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	$876,957
Employer contributions (assets) at end of year	2016-12-31	$876,957
Employer contributions (assets) at beginning of year	2016-12-31	$841,047
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$909,194
Contract administrator fees	2016-12-31	$5,153
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	PLANTE & MORAN, PLLC
Accountancy firm EIN	2016-12-31	381357951
2015 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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	$2,005,846
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$300,305
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$280,239
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$1,753,267
Value of total assets at end of year	2015-12-31	$14,165,095
Value of total assets at beginning of year	2015-12-31	$12,459,554
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$20,066
Total interest from all sources	2015-12-31	$251,668
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$38,431
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	$38,431
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$852,128
Participant contributions at end of year	2015-12-31	$7,103
Participant contributions at beginning of year	2015-12-31	$6,979
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$60,092
Total non interest bearing cash at end of year	2015-12-31	$4,542
Total non interest bearing cash at beginning of year	2015-12-31	$18,136
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	$1,705,541
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$14,165,095
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$12,459,554
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	$6,362,905
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$6,009,931
Interest earned on other investments	2015-12-31	$251,668
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$6,949,498
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$5,881,518
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-54,433
Net investment gain/loss from pooled separate accounts	2015-12-31	$16,913
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	$841,047
Employer contributions (assets) at end of year	2015-12-31	$841,047
Employer contributions (assets) at beginning of year	2015-12-31	$542,990
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$280,239
Contract administrator fees	2015-12-31	$20,066
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	PLANTE & MORAN, PLLC
Accountancy firm EIN	2015-12-31	381357951
2014 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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	$2,168,169
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$607,004
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$574,634
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,511,880
Value of total assets at end of year	2014-12-31	$12,459,554
Value of total assets at beginning of year	2014-12-31	$10,898,389
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$32,370
Total interest from all sources	2014-12-31	$215,277
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$70,747
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$70,747
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$850,703
Participant contributions at end of year	2014-12-31	$6,979
Participant contributions at beginning of year	2014-12-31	$7,188
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$118,187
Total non interest bearing cash at end of year	2014-12-31	$18,136
Total non interest bearing cash at beginning of year	2014-12-31	$2,364
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	$1,561,165
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$12,459,554
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$10,898,389
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	$6,009,931
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$5,106,425
Interest on participant loans	2014-12-31	$9
Interest earned on other investments	2014-12-31	$215,268
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$5,881,518
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$4,923,500
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$91,858
Net investment gain/loss from pooled separate accounts	2014-12-31	$278,407
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	$542,990
Employer contributions (assets) at end of year	2014-12-31	$542,990
Employer contributions (assets) at beginning of year	2014-12-31	$858,912
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$574,634
Contract administrator fees	2014-12-31	$32,370
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	PLANTE & MORAN, PLLC
Accountancy firm EIN	2014-12-31	381357951
2013 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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	$3,537,511
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$377,265
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$338,463
Value of total corrective distributions	2013-12-31	$5,360
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$2,494,705
Value of total assets at end of year	2013-12-31	$10,898,389
Value of total assets at beginning of year	2013-12-31	$7,738,143
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$33,442
Total interest from all sources	2013-12-31	$1,063
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$258,555
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$258,555
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$928,362
Participant contributions at end of year	2013-12-31	$7,188
Participant contributions at beginning of year	2013-12-31	$13,755
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$707,431
Total non interest bearing cash at end of year	2013-12-31	$2,364
Total non interest bearing cash at beginning of year	2013-12-31	$4,077
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	$3,160,246
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$10,898,389
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$7,738,143
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	$5,106,425
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$3,931,308
Interest on participant loans	2013-12-31	$49
Interest earned on other investments	2013-12-31	$1,014
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$4,923,500
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$2,884,531
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$266,085
Net investment gain/loss from pooled separate accounts	2013-12-31	$517,103
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	$858,912
Employer contributions (assets) at end of year	2013-12-31	$858,912
Employer contributions (assets) at beginning of year	2013-12-31	$904,472
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$338,463
Contract administrator fees	2013-12-31	$33,442
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	PLANTE & MORAN, PLLC
Accountancy firm EIN	2013-12-31	381357951
2012 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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	$2,978,022
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$1,704,078
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$1,680,589
Expenses. Certain deemed distributions of participant loans	2012-12-31	$4,494
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$2,414,292
Value of total assets at end of year	2012-12-31	$7,738,143
Value of total assets at beginning of year	2012-12-31	$6,464,199
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$18,995
Total interest from all sources	2012-12-31	$3,667
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$41,050
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$41,050
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	Yes
Amount of non-exempt transactions with any party-in-interest	2012-12-31	$2,828
Contributions received from participants	2012-12-31	$708,360
Participant contributions at end of year	2012-12-31	$13,755
Participant contributions at beginning of year	2012-12-31	$42,841
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$801,460
Total non interest bearing cash at end of year	2012-12-31	$4,077
Total non interest bearing cash at beginning of year	2012-12-31	$13,322
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	$1,273,944
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$7,738,143
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$6,464,199
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	$3,931,308
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$4,036,356
Value of interest in pooled separate accounts at end of year	2012-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$543,206
Interest on participant loans	2012-12-31	$93
Interest earned on other investments	2012-12-31	$3,574
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$2,884,531
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$1,828,474
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$234,150
Net investment gain/loss from pooled separate accounts	2012-12-31	$284,863
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	$904,472
Employer contributions (assets) at end of year	2012-12-31	$904,472
Employer contributions (assets) at beginning of year	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$1,680,589
Contract administrator fees	2012-12-31	$18,995
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	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2012-12-31	381357951
2011 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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	$973,859
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$615,821
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$593,992
Expenses. Certain deemed distributions of participant loans	2011-12-31	$2,500
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$946,962
Value of total assets at end of year	2011-12-31	$6,464,199
Value of total assets at beginning of year	2011-12-31	$6,106,161
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$19,329
Total interest from all sources	2011-12-31	$11,775
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$52,048
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$52,048
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
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	$533,059
Participant contributions at end of year	2011-12-31	$42,841
Participant contributions at beginning of year	2011-12-31	$2,498
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$20,468
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$413,903
Total non interest bearing cash at end of year	2011-12-31	$13,322
Total non interest bearing cash at beginning of year	2011-12-31	$18,524
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	$358,038
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$6,464,199
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$6,106,161
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	$4,036,356
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$4,452,902
Value of interest in pooled separate accounts at end of year	2011-12-31	$543,206
Interest on participant loans	2011-12-31	$1,076
Interest earned on other investments	2011-12-31	$10,699
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$1,828,474
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$1,611,769
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-16,776
Net investment gain/loss from pooled separate accounts	2011-12-31	$-20,150
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$593,992
Contract administrator fees	2011-12-31	$19,329
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	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2011-12-31	381357951
2010 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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	$1,383,181
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$615,765
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$598,534
Expenses. Certain deemed distributions of participant loans	2010-12-31	$5,714
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$803,745
Value of total assets at end of year	2010-12-31	$6,106,161
Value of total assets at beginning of year	2010-12-31	$5,338,745
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$11,517
Total interest from all sources	2010-12-31	$84,326
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	$500,000
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	$580,221
Participant contributions at end of year	2010-12-31	$2,498
Participant contributions at beginning of year	2010-12-31	$3,139
Participant contributions at end of year	2010-12-31	$20,468
Participant contributions at beginning of year	2010-12-31	$20,416
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$223,524
Total non interest bearing cash at end of year	2010-12-31	$18,524
Total non interest bearing cash at beginning of year	2010-12-31	$60,091
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	$767,416
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$6,106,161
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$5,338,745
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	$4,452,902
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$2,074,312
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$1,805,562
Interest on participant loans	2010-12-31	$174
Interest earned on other investments	2010-12-31	$84,152
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$1,611,769
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$1,375,225
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$316,714
Net investment gain/loss from pooled separate accounts	2010-12-31	$178,396
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$598,534
Contract administrator fees	2010-12-31	$11,517
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	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2010-12-31	381357951
2009 : COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN

2022: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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	No
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: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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
2018: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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 benefit arrangement – Insurance	Yes
2009: COMMUNITY HOSPITAL AND WELLNESS CENTER 403 (B) PLAN 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SECURITY BENEFIT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68675 )

Policy contract number

1301224789

Policy instance

Insurance contract or identification number	1301224789
Number of Individuals Covered	3
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF1018

Policy instance

Insurance contract or identification number	VF1018
Number of Individuals Covered	982
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $114,585
Total amount of fees paid to insurance company	USD $7,763
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $114,572
Amount paid for insurance broker fees	7763
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAID
Insurance broker organization code?	3

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

009091444A

Policy instance

Insurance contract or identification number	009091444A
Number of Individuals Covered	0
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF1018

Policy instance

Insurance contract or identification number	VF1018
Number of Individuals Covered	926
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $70,498
Total amount of fees paid to insurance company	USD $3,569
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $70,498
Amount paid for insurance broker fees	3569
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAID
Insurance broker organization code?	3

SECURITY BENEFIT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68675 )

Policy contract number

1301224789

Policy instance

Insurance contract or identification number	1301224789
Number of Individuals Covered	5
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

009091444A

Policy instance

Insurance contract or identification number	009091444A
Number of Individuals Covered	3
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

SECURITY BENEFIT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68675 )

Policy contract number

1301224789

Policy instance

Insurance contract or identification number	1301224789
Number of Individuals Covered	5
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF1018

Policy instance

Insurance contract or identification number	VF1018
Number of Individuals Covered	908
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $66,913
Total amount of fees paid to insurance company	USD $3,219
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $66,913
Amount paid for insurance broker fees	3219
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAID
Insurance broker organization code?	3

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

009091444A

Policy instance

Insurance contract or identification number	009091444A
Number of Individuals Covered	3
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF1018

Policy instance

Insurance contract or identification number	VF1018
Number of Individuals Covered	898
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $39,251
Total amount of fees paid to insurance company	USD $1,442
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $39,251
Amount paid for insurance broker fees	1442
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAID
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

CR31285

Policy instance

Insurance contract or identification number	CR31285
Number of Individuals Covered	1
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

SECURITY BENEFIT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68675 )

Policy contract number

1301224789

Policy instance

Insurance contract or identification number	1301224789
Number of Individuals Covered	5
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

SECURITY BENEFIT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68675 )

Policy contract number

1301224789

Policy instance

Insurance contract or identification number	1301224789
Number of Individuals Covered	5
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

CR31285

Policy instance

Insurance contract or identification number	CR31285
Number of Individuals Covered	2
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

009091444A

Policy instance

Insurance contract or identification number	009091444A
Number of Individuals Covered	2
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF1018

Policy instance

Insurance contract or identification number	VF1018
Number of Individuals Covered	863
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $47,105
Total amount of fees paid to insurance company	USD $3,441
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $47,105
Amount paid for insurance broker fees	3441
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAID
Insurance broker organization code?	3

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

009091444A

Policy instance

Insurance contract or identification number	009091444A
Number of Individuals Covered	2
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $714
Total amount of fees paid to insurance company	USD $0
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $714
Insurance broker organization code?	3
Insurance broker name	CAPITAL INVESTMENT GROUP INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

CR31285

Policy instance

Insurance contract or identification number	CR31285
Number of Individuals Covered	3
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF1018

Policy instance

Insurance contract or identification number	VF1018
Number of Individuals Covered	850
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $49,771
Total amount of fees paid to insurance company	USD $5,217
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $49,771
Amount paid for insurance broker fees	5217
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAID
Insurance broker organization code?	3
Insurance broker name	CARDONE TOBIAS

SECURITY BENEFIT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68675 )

Policy contract number

1301224789

Policy instance

Insurance contract or identification number	1301224789
Number of Individuals Covered	5
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF1018

Policy instance

Insurance contract or identification number	VF1018
Number of Individuals Covered	801
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $49,345
Total amount of fees paid to insurance company	USD $6,100
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $49,345
Amount paid for insurance broker fees	6100
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAID
Insurance broker organization code?	3
Insurance broker name	CARDONE TOBIAS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

CR31285

Policy instance

Insurance contract or identification number	CR31285
Number of Individuals Covered	4
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF1018

Policy instance

Insurance contract or identification number	VF1018
Number of Individuals Covered	802
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $62,465
Total amount of fees paid to insurance company	USD $11,258
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $62,436
Amount paid for insurance broker fees	11258
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAID ALLOCATED NON-CASH COMP
Insurance broker organization code?	3
Insurance broker name	KIENINGER FAITH

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

CR31285

Policy instance

Insurance contract or identification number	CR31285
Number of Individuals Covered	4
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

CR31285

Policy instance

Insurance contract or identification number	CR31285
Number of Individuals Covered	4
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF1018

Policy instance

Insurance contract or identification number	VF1018
Number of Individuals Covered	738
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $102,356
Total amount of fees paid to insurance company	USD $14,720
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $102,356
Amount paid for insurance broker fees	14720
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAID ALLOCATED NON-CASH COMP
Insurance broker organization code?	3
Insurance broker name	CARDONE TOBIAS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

CR31285

Policy instance

Insurance contract or identification number	CR31285
Number of Individuals Covered	7
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF1018

Policy instance

Insurance contract or identification number	VF1018
Number of Individuals Covered	415
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $50,264
Total amount of fees paid to insurance company	USD $7,389
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $50,264
Amount paid for insurance broker fees	7389
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAID
Insurance broker organization code?	3
Insurance broker name	CARDONE TOBIAS

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF1018

Policy instance

Insurance contract or identification number	VF1018
Number of Individuals Covered	136
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,683
Total amount of fees paid to insurance company	USD $1,609
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF1018

Policy instance

Insurance contract or identification number	VF1018
Number of Individuals Covered	122
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $7,286
Total amount of fees paid to insurance company	USD $1,077
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?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

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Company Name:	COMMUNITY HOSPITALS AND WELLNESS CENTERS
Employer identification number (EIN):	341048666
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1969-05-16
Company Identification Number:	384200
Legal Registered Office Address:	433 WEST HIGH ST - BRYAN United States of America (USA) 43506