401k Plan data: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN plan

COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 401k Plan overview

Plan Name	COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN
Plan identification number	001

COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met. Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.

401k Sponsoring company profile

COMMUNITY HOSPITAL OF SAN BERNARDINO has sponsored the creation of one or more 401k plans.

Company Name: COMMUNITY HOSPITAL OF SAN BERNARDINO

Employer identification number (EIN): 951643373

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about COMMUNITY HOSPITAL OF SAN BERNARDINO

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C0175659

More information about COMMUNITY HOSPITAL OF SAN BERNARDINO

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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
001 2017-01-01 DAVE EVANS
001 2016-01-01 DAVE EVANS DAVE EVANS 2017-10-05
001 2015-01-01 DAVE EVANS DAVE EVANS 2016-10-13
001 2014-01-01 DAVE EVANS DAVE EVANS 2015-10-15
001 2013-01-01 DAVE EVANS DAVE EVANS 2014-10-14
001 2012-01-01 DAVE EVANS DAVE EVANS 2013-10-15
001 2011-01-01 DAVE EVANS
001 2009-01-01 DAVE EVANS
001 2009-01-01 DAVE EVANS
001 2009-01-01 DAVE EVANS

Plan id#	Filing Submission Date	Name of Administrator	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
001	2017-01-01	DAVE EVANS
001	2016-01-01	DAVE EVANS	DAVE EVANS	2017-10-05
001	2015-01-01	DAVE EVANS	DAVE EVANS	2016-10-13
001	2014-01-01	DAVE EVANS	DAVE EVANS	2015-10-15
001	2013-01-01	DAVE EVANS	DAVE EVANS	2014-10-14
001	2012-01-01	DAVE EVANS	DAVE EVANS	2013-10-15
001	2011-01-01	DAVE EVANS
001	2009-01-01	DAVE EVANS
001	2009-01-01	DAVE EVANS
001	2009-01-01	DAVE EVANS

Plan Statistics for COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN

401k plan membership statisitcs for COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN

Measure Date Value
2022: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 589
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 75
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 325
Total of all active and inactive participants 2022-01-01 400
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 1
Total participants 2022-01-01 401
Number of participants with account balances 2022-01-01 401
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 586
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 87
Number of retired or separated participants receiving benefits 2021-01-01 13
Number of other retired or separated participants entitled to future benefits 2021-01-01 480
Total of all active and inactive participants 2021-01-01 580
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 9
Total participants 2021-01-01 589
Number of participants with account balances 2021-01-01 568
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 606
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 95
Number of retired or separated participants receiving benefits 2020-01-01 24
Number of other retired or separated participants entitled to future benefits 2020-01-01 492
Total of all active and inactive participants 2020-01-01 611
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 7
Total participants 2020-01-01 618
Number of participants with account balances 2020-01-01 586
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 392
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 371
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 371
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 371
Number of participants with account balances 2019-01-01 0
2018: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 696
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 676
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 676
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 676
Number of participants with account balances 2018-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 721
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 696
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 696
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 696
Number of participants with account balances 2017-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 747
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 721
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 0
Total of all active and inactive participants 2016-01-01 721
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 721
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 801
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 747
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 0
Total of all active and inactive participants 2015-01-01 747
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 747
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 838
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 801
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 0
Total of all active and inactive participants 2014-01-01 801
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 801
Number of participants with account balances 2014-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 901
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 838
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 838
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 838
Number of participants with account balances 2013-01-01 838
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 938
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 848
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 53
Total of all active and inactive participants 2012-01-01 901
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 901
Number of participants with account balances 2012-01-01 901
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,027
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 928
Total of all active and inactive participants 2011-01-01 928
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 10
Total participants 2011-01-01 938
Number of participants with account balances 2011-01-01 938
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,065
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,065
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 0
Total of all active and inactive participants 2009-01-01 1,065
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 1,065
Number of participants with account balances 2009-01-01 1,065
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 OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	589
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	75
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	325
Total of all active and inactive participants	2022-01-01	400
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	1
Total participants	2022-01-01	401
Number of participants with account balances	2022-01-01	401
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	586
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	87
Number of retired or separated participants receiving benefits	2021-01-01	13
Number of other retired or separated participants entitled to future benefits	2021-01-01	480
Total of all active and inactive participants	2021-01-01	580
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	9
Total participants	2021-01-01	589
Number of participants with account balances	2021-01-01	568
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	606
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	95
Number of retired or separated participants receiving benefits	2020-01-01	24
Number of other retired or separated participants entitled to future benefits	2020-01-01	492
Total of all active and inactive participants	2020-01-01	611
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	7
Total participants	2020-01-01	618
Number of participants with account balances	2020-01-01	586
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	392
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	371
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	371
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	371
Number of participants with account balances	2019-01-01	0
2018: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	696
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	676
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	676
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	676
Number of participants with account balances	2018-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	721
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	696
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	696
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	696
Number of participants with account balances	2017-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	747
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	721
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	0
Total of all active and inactive participants	2016-01-01	721
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	721
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	801
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	747
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	0
Total of all active and inactive participants	2015-01-01	747
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	747
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	838
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	801
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	0
Total of all active and inactive participants	2014-01-01	801
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	801
Number of participants with account balances	2014-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	901
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	838
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	838
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	838
Number of participants with account balances	2013-01-01	838
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	938
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	848
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	53
Total of all active and inactive participants	2012-01-01	901
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	901
Number of participants with account balances	2012-01-01	901
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,027
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	928
Total of all active and inactive participants	2011-01-01	928
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	10
Total participants	2011-01-01	938
Number of participants with account balances	2011-01-01	938
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,065
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,065
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	0
Total of all active and inactive participants	2009-01-01	1,065
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	1,065
Number of participants with account balances	2009-01-01	1,065
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 OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN

Measure	Date	Value
2022 : COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2022 401k financial data
Total income from all sources (including contributions)	2022-12-31	$-632,392
Total of all expenses incurred	2022-12-31	$1,050,274
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$1,050,199
Value of total assets at end of year	2022-12-31	$5,080,159
Value of total assets at beginning of year	2022-12-31	$6,762,825
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$75
Total interest from all sources	2022-12-31	$105,060
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
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
Participant contributions at end of year	2022-12-31	$3,958
Participant contributions at beginning of year	2022-12-31	$4,107
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	$-1,682,666
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$5,080,159
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$6,762,825
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	$1,986,026
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$3,078,383
Interest on participant loans	2022-12-31	$119
Interest earned on other investments	2022-12-31	$104,941
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$3,090,175
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$3,680,335
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$766,398
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-737,452
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$283,801
Contract administrator fees	2022-12-31	$75
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	SWENSON CORPORATION
Accountancy firm EIN	2022-12-31	330305868
2021 : COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-12-31	$570,592
Total of all expenses incurred	2021-12-31	$478,755
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$478,655
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$28,936
Value of total assets at end of year	2021-12-31	$6,762,825
Value of total assets at beginning of year	2021-12-31	$6,670,988
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$100
Total interest from all sources	2021-12-31	$118,004
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$1,000,000
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
Participant contributions at end of year	2021-12-31	$4,107
Participant contributions at beginning of year	2021-12-31	$3,987
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$28,936
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	$91,837
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$6,762,825
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$6,670,988
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	$3,078,383
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$2,933,625
Interest on participant loans	2021-12-31	$120
Interest earned on other investments	2021-12-31	$117,884
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$3,680,335
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$3,733,376
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$199,832
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$423,652
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$278,823
Contract administrator fees	2021-12-31	$100
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	Disclaimer
Accountancy firm name	2021-12-31	SWENSON CORPORATION
Accountancy firm EIN	2021-12-31	330305868
2020 : COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$674,792
Total of all expenses incurred	2020-12-31	$231,701
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$231,601
Value of total assets at end of year	2020-12-31	$6,670,988
Value of total assets at beginning of year	2020-12-31	$6,227,897
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$100
Total interest from all sources	2020-12-31	$118,083
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
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
Participant contributions at end of year	2020-12-31	$3,987
Participant contributions at beginning of year	2020-12-31	$4,902
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	$443,091
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$6,670,988
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$6,227,897
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	$2,933,625
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$2,467,022
Interest on participant loans	2020-12-31	$113
Interest earned on other investments	2020-12-31	$117,970
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$3,733,376
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$3,755,973
Expenses. Payments to insurance carriers foe the provision of benefits	2020-12-31	$186,246
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$556,709
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$45,355
Contract administrator fees	2020-12-31	$100
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	Disclaimer
Accountancy firm name	2020-12-31	SWENSON CORPORATION
Accountancy firm EIN	2020-12-31	330305868
2019 : COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$664,802
Total of all expenses incurred	2019-12-31	$443,883
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$441,927
Expenses. Certain deemed distributions of participant loans	2019-12-31	$-476
Value of total corrective distributions	2019-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$11,537
Value of total assets at end of year	2019-12-31	$6,227,897
Value of total assets at beginning of year	2019-12-31	$6,006,978
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$2,432
Total interest from all sources	2019-12-31	$119,229
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$0
Participant contributions at end of year	2019-12-31	$4,902
Participant contributions at beginning of year	2019-12-31	$5,657
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$9,205
Administrative expenses (other) incurred	2019-12-31	$2,332
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	$220,919
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$6,227,897
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$6,006,978
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	$2,467,022
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$2,218,521
Interest on participant loans	2019-12-31	$130
Interest earned on other investments	2019-12-31	$119,099
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$3,755,973
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$3,782,800
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$534,036
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	$2,332
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$441,927
Contract administrator fees	2019-12-31	$100
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	SWENSON CORPORATION
Accountancy firm EIN	2019-12-31	330305868
2018 : COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$-36,893
Total of all expenses incurred	2018-12-31	$419,398
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$375,801
Expenses. Certain deemed distributions of participant loans	2018-12-31	$-2,362
Value of total assets at end of year	2018-12-31	$6,006,978
Value of total assets at beginning of year	2018-12-31	$6,463,269
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$45,959
Total interest from all sources	2018-12-31	$119,776
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Participant contributions at end of year	2018-12-31	$5,657
Participant contributions at beginning of year	2018-12-31	$9,156
Administrative expenses (other) incurred	2018-12-31	$45,834
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	$-456,291
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$6,006,978
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$6,463,269
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	$2,218,521
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$2,615,685
Interest on participant loans	2018-12-31	$164
Interest earned on other investments	2018-12-31	$119,612
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$3,782,800
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$3,838,428
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-156,669
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$375,801
Contract administrator fees	2018-12-31	$125
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	SWENSON CORPORATION
Accountancy firm EIN	2018-12-31	330305868
2017 : COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$580,036
Total of all expenses incurred	2017-12-31	$462,453
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$467,447
Expenses. Certain deemed distributions of participant loans	2017-12-31	$-5,119
Value of total assets at end of year	2017-12-31	$6,463,269
Value of total assets at beginning of year	2017-12-31	$6,345,686
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$125
Total interest from all sources	2017-12-31	$121,105
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Participant contributions at end of year	2017-12-31	$9,156
Participant contributions at beginning of year	2017-12-31	$11,882
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	$117,583
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$6,463,269
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$6,345,686
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	$2,615,685
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$2,509,749
Interest on participant loans	2017-12-31	$260
Interest earned on other investments	2017-12-31	$120,845
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$3,838,428
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$3,824,055
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$458,931
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$467,447
Contract administrator fees	2017-12-31	$125
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	SWENSON CORPORATION
Accountancy firm EIN	2017-12-31	330305868
2016 : COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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	$309,792
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$424,884
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$429,328
Expenses. Certain deemed distributions of participant loans	2016-12-31	$-4,569
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$0
Value of total assets at end of year	2016-12-31	$6,345,686
Value of total assets at beginning of year	2016-12-31	$6,460,778
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$125
Total interest from all sources	2016-12-31	$122,467
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Participant contributions at end of year	2016-12-31	$11,882
Participant contributions at beginning of year	2016-12-31	$20,467
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	$-115,092
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$6,345,686
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$6,460,778
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	$2,509,749
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$2,533,074
Interest on participant loans	2016-12-31	$370
Interest earned on other investments	2016-12-31	$122,097
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$3,824,055
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$3,907,237
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$187,325
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$429,328
Contract administrator fees	2016-12-31	$125
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	SWENSON CORPORATION
Accountancy firm EIN	2016-12-31	330305865
2015 : COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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	$84,841
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$419,870
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$419,813
Expenses. Certain deemed distributions of participant loans	2015-12-31	$-135
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$0
Value of total assets at end of year	2015-12-31	$6,460,778
Value of total assets at beginning of year	2015-12-31	$6,795,807
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$192
Total interest from all sources	2015-12-31	$122,532
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Participant contributions at end of year	2015-12-31	$20,467
Participant contributions at beginning of year	2015-12-31	$20,459
Administrative expenses (other) incurred	2015-12-31	$10
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	$-335,029
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$6,460,778
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$6,795,807
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	$2,533,074
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,943,369
Interest on participant loans	2015-12-31	$535
Interest earned on other investments	2015-12-31	$121,997
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$3,907,237
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$3,831,979
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-37,691
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$419,813
Contract administrator fees	2015-12-31	$182
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	SWENSON CORPORATION
Accountancy firm EIN	2015-12-31	330305865
2014 : COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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	$361,880
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$600,871
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$600,708
Expenses. Certain deemed distributions of participant loans	2014-12-31	$-37
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$0
Value of total assets at end of year	2014-12-31	$6,795,807
Value of total assets at beginning of year	2014-12-31	$7,034,798
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$200
Total interest from all sources	2014-12-31	$126,270
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Participant contributions at end of year	2014-12-31	$20,459
Participant contributions at beginning of year	2014-12-31	$23,039
Administrative expenses (other) incurred	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-238,991
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$6,795,807
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$7,034,798
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	$2,943,369
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$2,935,064
Interest on participant loans	2014-12-31	$573
Interest earned on other investments	2014-12-31	$125,697
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$3,831,979
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$4,076,695
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$235,610
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	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$600,708
Contract administrator fees	2014-12-31	$200
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	SWENSON CORPORATION
Accountancy firm EIN	2014-12-31	330305865
2013 : COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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	$609,403
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$998,571
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$995,222
Expenses. Certain deemed distributions of participant loans	2013-12-31	$-5,212
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$0
Value of total assets at end of year	2013-12-31	$7,034,798
Value of total assets at beginning of year	2013-12-31	$7,423,966
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$8,561
Total interest from all sources	2013-12-31	$137,787
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Participant contributions at end of year	2013-12-31	$23,039
Participant contributions at beginning of year	2013-12-31	$36,396
Administrative expenses (other) incurred	2013-12-31	$8,321
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	$-389,168
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$7,034,798
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$7,423,966
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	$2,935,064
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$2,818,021
Interest on participant loans	2013-12-31	$716
Interest earned on other investments	2013-12-31	$137,071
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$4,076,695
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$4,569,549
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$471,616
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$995,222
Contract administrator fees	2013-12-31	$240
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	SWENSON CORPORATION
Accountancy firm EIN	2013-12-31	330305865
2012 : COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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	$471,264
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$959,617
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$964,618
Expenses. Certain deemed distributions of participant loans	2012-12-31	$-3,388
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$0
Value of total assets at end of year	2012-12-31	$7,423,966
Value of total assets at beginning of year	2012-12-31	$7,912,319
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$-1,613
Total interest from all sources	2012-12-31	$152,516
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Participant contributions at end of year	2012-12-31	$36,396
Participant contributions at beginning of year	2012-12-31	$64,412
Administrative expenses (other) incurred	2012-12-31	$-1,863
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	$-488,353
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$7,423,966
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$7,912,319
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	$2,818,021
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$2,888,776
Interest on participant loans	2012-12-31	$1,402
Interest earned on other investments	2012-12-31	$151,114
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$4,569,549
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$4,959,131
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$318,748
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$964,618
Contract administrator fees	2012-12-31	$250
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	SWENSON CORPORATION
Accountancy firm EIN	2012-12-31	330305865
2011 : COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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	$199,186
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$967,673
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$968,513
Expenses. Certain deemed distributions of participant loans	2011-12-31	$-1,227
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$0
Value of total assets at end of year	2011-12-31	$7,912,319
Value of total assets at beginning of year	2011-12-31	$8,680,806
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$387
Total interest from all sources	2011-12-31	$164,839
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Participant contributions at end of year	2011-12-31	$64,412
Participant contributions at beginning of year	2011-12-31	$76,411
Administrative expenses (other) incurred	2011-12-31	$8
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	$-768,487
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$7,912,319
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$8,680,806
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	$2,888,776
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$3,252,999
Interest on participant loans	2011-12-31	$2,097
Interest earned on other investments	2011-12-31	$162,742
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$4,959,131
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$5,351,396
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$34,347
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	$968,513
Contract administrator fees	2011-12-31	$379
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	SWENSON CORPORATION
Accountancy firm EIN	2011-12-31	330305865
2010 : COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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	$547,022
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$781,525
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$782,755
Expenses. Certain deemed distributions of participant loans	2010-12-31	$-1,538
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$0
Value of total assets at end of year	2010-12-31	$8,680,806
Value of total assets at beginning of year	2010-12-31	$8,915,309
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$308
Total interest from all sources	2010-12-31	$178,637
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Participant contributions at end of year	2010-12-31	$76,411
Participant contributions at beginning of year	2010-12-31	$93,981
Administrative expenses (other) incurred	2010-12-31	$8
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	$-234,503
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$8,680,806
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$8,915,309
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	$3,252,999
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$3,096,955
Interest on participant loans	2010-12-31	$2,298
Interest earned on other investments	2010-12-31	$176,339
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$5,351,396
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$5,724,373
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$368,385
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	$782,755
Contract administrator fees	2010-12-31	$300
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	SWENSON ACCOUNTANCY CORPORATION
Accountancy firm EIN	2010-12-31	330305865

Form 5500 Responses for COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN

2022: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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 benefit arrangement – Insurance	Yes
2015: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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 benefit arrangement – Insurance	Yes
2014: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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 benefit arrangement – Insurance	Yes
2013: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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 benefit arrangement – Insurance	Yes
2012: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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 benefit arrangement – Insurance	Yes
2011: COMMUNITY HOSPITAL OF SAN BERNARDINO TAX SHELTERED ANNUITY 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 OF SAN BERNARDINO TAX SHELTERED ANNUITY 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

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

Policy contract number

093392-030

Policy instance

Insurance contract or identification number	093392-030
Number of Individuals Covered	78
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $38
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38
Insurance broker organization code?	4

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

55295

Policy instance

Insurance contract or identification number	55295
Number of Individuals Covered	334
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $879
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $759
Insurance broker organization code?	3

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

Policy contract number

093392-030

Policy instance

Insurance contract or identification number	093392-030
Number of Individuals Covered	251
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

55295

Policy instance

Insurance contract or identification number	55295
Number of Individuals Covered	348
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,100
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $950
Insurance broker organization code?	3

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

Policy contract number

093392-030

Policy instance

Insurance contract or identification number	093392-030
Number of Individuals Covered	254
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

55295

Policy instance

Insurance contract or identification number	55295
Number of Individuals Covered	363
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,009
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $889
Insurance broker organization code?	3

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

55295

Policy instance

Insurance contract or identification number	55295
Number of Individuals Covered	371
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,006
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $870
Insurance broker organization code?	3

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

Policy contract number

093392-030

Policy instance

Insurance contract or identification number	093392-030
Number of Individuals Covered	265
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,950
Insurance broker organization code?	4

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

55295

Policy instance

Insurance contract or identification number	55295
Number of Individuals Covered	392
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $877
Insurance broker organization code?	3

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

Policy contract number

093392-030

Policy instance

Insurance contract or identification number	093392-030
Number of Individuals Covered	267
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $127
Insurance broker organization code?	4

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

Policy contract number

093392-030

Policy instance

Insurance contract or identification number	093392-030
Number of Individuals Covered	281
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

55295

Policy instance

Insurance contract or identification number	55295
Number of Individuals Covered	412
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,024
Insurance broker organization code?	3
Insurance broker name	HERSCH, GARY A

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

Policy contract number

093392-030

Policy instance

Insurance contract or identification number	093392-030
Number of Individuals Covered	295
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $422
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?	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
Commission paid to Insurance Broker	USD $422
Insurance broker organization code?	4
Insurance broker name	LINCOLN FINANCIAL ADVISORS COR

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

55295

Policy instance

Insurance contract or identification number	55295
Number of Individuals Covered	454
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,120
Total amount of fees paid to insurance company	USD $0
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	1
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
Commission paid to Insurance Broker	USD $987
Insurance broker organization code?	3
Insurance broker name	HERSCH, GARY A

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

Policy contract number

093392-030

Policy instance

Insurance contract or identification number	093392-030
Number of Individuals Covered	309
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,268
Total amount of fees paid to insurance company	USD $0
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?	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
Commission paid to Insurance Broker	USD $1,268
Insurance broker organization code?	4
Insurance broker name	LINCOLN FINANCIAL ADVISORS COR

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

55295

Policy instance

Insurance contract or identification number	55295
Number of Individuals Covered	478
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,442
Total amount of fees paid to insurance company	USD $0
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	1
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
Commission paid to Insurance Broker	USD $2,136
Insurance broker organization code?	3
Insurance broker name	KORMOS, MICHAEL B

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

55295

Policy instance

Insurance contract or identification number	55295
Number of Individuals Covered	514
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,528
Total amount of fees paid to insurance company	USD $0
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?	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
Commission paid to Insurance Broker	USD $2,241
Insurance broker organization code?	3
Insurance broker name	ADMIN 25, HOME OFFICE

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

Policy contract number

093392-030

Policy instance

Insurance contract or identification number	093392-030
Number of Individuals Covered	324
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,565
Total amount of fees paid to insurance company	USD $0
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?	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
Commission paid to Insurance Broker	USD $1,565
Insurance broker organization code?	4
Insurance broker name	LINCOLN FINANCIAL ADVISORS COR

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

Policy contract number

093392-030

Policy instance

Insurance contract or identification number	093392-030
Number of Individuals Covered	348
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,365
Total amount of fees paid to insurance company	USD $0
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?	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
Commission paid to Insurance Broker	USD $1,365
Insurance broker organization code?	4
Insurance broker name	LINCOLN FINANCIAL ADVISORS COR

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

55295

Policy instance

Insurance contract or identification number	55295
Number of Individuals Covered	553
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,178
Total amount of fees paid to insurance company	USD $0
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?	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
Commission paid to Insurance Broker	USD $1,932
Insurance broker organization code?	3
Insurance broker name	POLOS, HELEN M

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

Policy contract number

093392-030

Policy instance

Insurance contract or identification number	093392-030
Number of Individuals Covered	357
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,731
Total amount of fees paid to insurance company	USD $0
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?	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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

55295

Policy instance

Insurance contract or identification number	55295
Number of Individuals Covered	581
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,189
Total amount of fees paid to insurance company	USD $0
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?	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

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

Policy contract number

093392-030

Policy instance

Insurance contract or identification number	093392-030
Number of Individuals Covered	366
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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?	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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

55295

Policy instance

Insurance contract or identification number	55295
Number of Individuals Covered	626
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,750
Total amount of fees paid to insurance company	USD $0
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?	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

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The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
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Company Name:	COMMUNITY HOSPITAL OF SAN BERNARDINO
Employer identification number (EIN):	951643373
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C0175659