401k Plan data: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN plan

ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 401k Plan overview

Plan Name	ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN
Plan identification number	002

ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

ANDROSCOGGIN VALLEY HOSPITAL, INC. has sponsored the creation of one or more 401k plans.

Company Name: ANDROSCOGGIN VALLEY HOSPITAL, INC.

Employer identification number (EIN): 020280367

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2017-01-01 LINDA ARSENAULT
002 2016-01-01 LINDA ARSENAULT
002 2015-01-01 JOHN MORRIS
002 2014-01-01 JOHN MORRIS
002 2013-01-01 JOHN MORRIS
002 2012-01-01 JOHN MORRIS JOHN MORRIS 2013-10-10
002 2011-01-01 JOHN MORRIS JOHN MORRIS 2012-10-03
002 2009-01-01 JOHN MORRIS JOHN MORRIS 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2017-01-01	LINDA ARSENAULT
002	2016-01-01	LINDA ARSENAULT
002	2015-01-01	JOHN MORRIS
002	2014-01-01	JOHN MORRIS
002	2013-01-01	JOHN MORRIS
002	2012-01-01	JOHN MORRIS	JOHN MORRIS	2013-10-10
002	2011-01-01	JOHN MORRIS	JOHN MORRIS	2012-10-03
002	2009-01-01	JOHN MORRIS	JOHN MORRIS	2010-10-14

Plan Statistics for ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN

401k plan membership statisitcs for ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN

Measure Date Value
2017: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 360
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
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 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 0
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: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 366
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 308
Number of retired or separated participants receiving benefits 2016-01-01 3
Number of other retired or separated participants entitled to future benefits 2016-01-01 49
Total of all active and inactive participants 2016-01-01 360
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 360
Number of participants with account balances 2016-01-01 343
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 381
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 340
Number of retired or separated participants receiving benefits 2015-01-01 2
Number of other retired or separated participants entitled to future benefits 2015-01-01 23
Total of all active and inactive participants 2015-01-01 365
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 1
Total participants 2015-01-01 366
Number of participants with account balances 2015-01-01 354
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 391
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 350
Number of retired or separated participants receiving benefits 2014-01-01 3
Number of other retired or separated participants entitled to future benefits 2014-01-01 28
Total of all active and inactive participants 2014-01-01 381
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 381
Number of participants with account balances 2014-01-01 361
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 460
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 364
Number of retired or separated participants receiving benefits 2013-01-01 2
Number of other retired or separated participants entitled to future benefits 2013-01-01 25
Total of all active and inactive participants 2013-01-01 391
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 391
Number of participants with account balances 2013-01-01 382
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 465
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 405
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 54
Total of all active and inactive participants 2012-01-01 460
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 460
Number of participants with account balances 2012-01-01 405
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 529
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 407
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 58
Total of all active and inactive participants 2011-01-01 465
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 465
Number of participants with account balances 2011-01-01 409
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 337
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 513
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 5
Total of all active and inactive participants 2009-01-01 518
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 518
Number of participants with account balances 2009-01-01 410
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2017: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	360
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
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	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	0
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: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	366
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	308
Number of retired or separated participants receiving benefits	2016-01-01	3
Number of other retired or separated participants entitled to future benefits	2016-01-01	49
Total of all active and inactive participants	2016-01-01	360
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	360
Number of participants with account balances	2016-01-01	343
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	381
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	340
Number of retired or separated participants receiving benefits	2015-01-01	2
Number of other retired or separated participants entitled to future benefits	2015-01-01	23
Total of all active and inactive participants	2015-01-01	365
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	1
Total participants	2015-01-01	366
Number of participants with account balances	2015-01-01	354
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	391
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	350
Number of retired or separated participants receiving benefits	2014-01-01	3
Number of other retired or separated participants entitled to future benefits	2014-01-01	28
Total of all active and inactive participants	2014-01-01	381
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	381
Number of participants with account balances	2014-01-01	361
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	460
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	364
Number of retired or separated participants receiving benefits	2013-01-01	2
Number of other retired or separated participants entitled to future benefits	2013-01-01	25
Total of all active and inactive participants	2013-01-01	391
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	391
Number of participants with account balances	2013-01-01	382
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	465
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	405
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	54
Total of all active and inactive participants	2012-01-01	460
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	460
Number of participants with account balances	2012-01-01	405
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	529
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	407
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	58
Total of all active and inactive participants	2011-01-01	465
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	465
Number of participants with account balances	2011-01-01	409
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	337
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	513
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	5
Total of all active and inactive participants	2009-01-01	518
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	518
Number of participants with account balances	2009-01-01	410
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN

Measure	Date	Value
2017 : ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-10-31	$0
Total transfer of assets from this plan	2017-10-31	$20,883,410
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-10-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-10-31	$0
Total income from all sources (including contributions)	2017-10-31	$3,125,855
Total loss/gain on sale of assets	2017-10-31	$0
Total of all expenses incurred	2017-10-31	$1,069,973
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-10-31	$1,027,139
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-10-31	$1,248,537
Value of total assets at end of year	2017-10-31	$0
Value of total assets at beginning of year	2017-10-31	$18,827,528
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-10-31	$42,834
Total interest from all sources	2017-10-31	$105,550
Total dividends received (eg from common stock, registered investment company shares)	2017-10-31	$137,550
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-10-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2017-10-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2017-10-31	$137,550
Was this plan covered by a fidelity bond	2017-10-31	Yes
Value of fidelity bond cover	2017-10-31	$1,000,000
If this is an individual account plan, was there a blackout period	2017-10-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-10-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-10-31	No
Contributions received from participants	2017-10-31	$920,917
Participant contributions at end of year	2017-10-31	$0
Participant contributions at beginning of year	2017-10-31	$180,949
Income. Received or receivable in cash from other sources (including rollovers)	2017-10-31	$88,351
Other income not declared elsewhere	2017-10-31	$42,297
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-10-31	No
Value of net income/loss	2017-10-31	$2,055,882
Value of net assets at end of year (total assets less liabilities)	2017-10-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2017-10-31	$18,827,528
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-10-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-10-31	No
Were any leases to which the plan was party in default or uncollectible	2017-10-31	No
Investment advisory and management fees	2017-10-31	$42,297
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-10-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-10-31	$12,396,799
Interest on participant loans	2017-10-31	$8,669
Interest earned on other investments	2017-10-31	$96,881
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-10-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-10-31	$6,249,780
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-10-31	$1,591,921
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-10-31	No
Was there a failure to transmit to the plan any participant contributions	2017-10-31	No
Has the plan failed to provide any benefit when due under the plan	2017-10-31	No
Contributions received in cash from employer	2017-10-31	$239,269
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-10-31	$1,027,139
Contract administrator fees	2017-10-31	$537
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-10-31	Yes
Did the plan have assets held for investment	2017-10-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-10-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-10-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-10-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-10-31	Disclaimer
Accountancy firm name	2017-10-31	TAWNEY, PLLC
Accountancy firm EIN	2017-10-31	464585449
2016 : ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT 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	$6,458,044
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$1,566,938
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$1,522,065
Expenses. Certain deemed distributions of participant loans	2016-12-31	$3,632
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$5,263,017
Value of total assets at end of year	2016-12-31	$18,827,528
Value of total assets at beginning of year	2016-12-31	$13,936,422
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$41,241
Total interest from all sources	2016-12-31	$106,218
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$550,524
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$550,524
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$1,120,167
Participant contributions at end of year	2016-12-31	$180,949
Participant contributions at beginning of year	2016-12-31	$186,533
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$3,837,189
Other income not declared elsewhere	2016-12-31	$41,309
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	$4,891,106
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$18,827,528
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$13,936,422
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
Investment advisory and management fees	2016-12-31	$40,510
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$12,396,799
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$9,489,290
Interest on participant loans	2016-12-31	$8,542
Interest earned on other investments	2016-12-31	$97,676
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$6,249,780
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$4,260,599
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$496,976
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$305,661
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$1,522,065
Contract administrator fees	2016-12-31	$731
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	TAWNEY, PLLC
Accountancy firm EIN	2016-12-31	464585449
2015 : ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT 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	$1,459,681
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$1,219,238
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$1,181,687
Expenses. Certain deemed distributions of participant loans	2015-12-31	$1,786
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$1,468,562
Value of total assets at end of year	2015-12-31	$13,936,422
Value of total assets at beginning of year	2015-12-31	$13,695,979
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$35,765
Total interest from all sources	2015-12-31	$81,771
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$617,608
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$617,608
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$1,140,723
Participant contributions at end of year	2015-12-31	$186,533
Participant contributions at beginning of year	2015-12-31	$169,484
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$29,506
Other income not declared elsewhere	2015-12-31	$35,046
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	$240,443
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$13,936,422
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$13,695,979
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
Investment advisory and management fees	2015-12-31	$35,046
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$9,489,290
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$9,641,946
Interest on participant loans	2015-12-31	$10,409
Interest earned on other investments	2015-12-31	$71,362
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$4,260,599
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$3,884,549
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-743,306
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$298,333
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$1,181,687
Contract administrator fees	2015-12-31	$719
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	BERRY, DUNN, MCNEIL & PARKER, LLC
Accountancy firm EIN	2015-12-31	010523282
2014 : ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT 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	$1,970,052
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$747,256
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$713,665
Expenses. Certain deemed distributions of participant loans	2014-12-31	$967
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,409,913
Value of total assets at end of year	2014-12-31	$13,695,979
Value of total assets at beginning of year	2014-12-31	$12,473,183
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$32,624
Total interest from all sources	2014-12-31	$70,045
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$659,624
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$659,624
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$1,048,575
Participant contributions at end of year	2014-12-31	$169,484
Participant contributions at beginning of year	2014-12-31	$175,915
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$61,928
Other income not declared elsewhere	2014-12-31	$31,974
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$1,222,796
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$13,695,979
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$12,473,183
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
Investment advisory and management fees	2014-12-31	$31,974
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$9,641,946
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$8,887,451
Interest on participant loans	2014-12-31	$7,718
Interest earned on other investments	2014-12-31	$62,327
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$3,884,549
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$3,409,817
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$-201,504
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	$299,410
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$713,665
Contract administrator fees	2014-12-31	$650
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	TYLER, SIMMS & ST. SAUVEUR, P.C.
Accountancy firm EIN	2014-12-31	020476956
2013 : ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$3,118,498
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$781,709
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$731,863
Expenses. Certain deemed distributions of participant loans	2013-12-31	$22,172
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$1,473,872
Value of total assets at end of year	2013-12-31	$12,473,183
Value of total assets at beginning of year	2013-12-31	$10,136,394
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$27,674
Total interest from all sources	2013-12-31	$59,423
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$540,970
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$540,970
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$1,153,575
Participant contributions at end of year	2013-12-31	$175,915
Participant contributions at beginning of year	2013-12-31	$164,272
Other income not declared elsewhere	2013-12-31	$27,124
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	$2,336,789
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$12,473,183
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$10,136,394
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
Investment advisory and management fees	2013-12-31	$27,124
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$8,887,451
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$7,227,167
Interest on participant loans	2013-12-31	$6,270
Interest earned on other investments	2013-12-31	$53,153
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$3,409,817
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$2,744,955
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$1,017,109
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$320,297
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$731,863
Contract administrator fees	2013-12-31	$550
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	TYLER SIMMS & ST. SAUVEUR
Accountancy firm EIN	2013-12-31	020476956
2012 : ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT 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	$3,544
Total income from all sources (including contributions)	2012-12-31	$2,468,832
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$410,823
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$400,464
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$1,626,935
Value of total assets at end of year	2012-12-31	$10,136,394
Value of total assets at beginning of year	2012-12-31	$8,081,929
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$10,359
Total interest from all sources	2012-12-31	$51,619
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$188,328
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$188,328
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$1,187,347
Participant contributions at end of year	2012-12-31	$164,272
Participant contributions at beginning of year	2012-12-31	$85,043
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$114,690
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$3,543
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$3,544
Other income not declared elsewhere	2012-12-31	$5,045
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
Income. Non cash contributions	2012-12-31	$0
Value of net income/loss	2012-12-31	$2,058,009
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$10,136,394
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$8,078,385
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
Investment advisory and management fees	2012-12-31	$5,045
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$7,227,167
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$5,578,725
Interest on participant loans	2012-12-31	$5,871
Interest earned on other investments	2012-12-31	$45,748
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$3,151
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$3,151
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$2,744,955
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$2,411,467
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$596,905
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$324,898
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$400,464
Contract administrator fees	2012-12-31	$5,314
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	TYLER SIMMS & ST. SAUVEUR
Accountancy firm EIN	2012-12-31	020476956
2011 : ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT 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	$3,544
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$62,021
Total income from all sources (including contributions)	2011-12-31	$1,556,505
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$211,957
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$203,039
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$1,604,461
Value of total assets at end of year	2011-12-31	$8,081,929
Value of total assets at beginning of year	2011-12-31	$6,795,858
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$8,918
Total interest from all sources	2011-12-31	$40,299
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$132,046
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$132,046
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$1,147,907
Participant contributions at end of year	2011-12-31	$85,043
Participant contributions at beginning of year	2011-12-31	$76,871
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$145,210
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$3,543
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$3,199
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$3,544
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$62,021
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$1,344,548
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$8,078,385
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$6,733,837
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	$5,578,725
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$4,873,022
Interest on participant loans	2011-12-31	$3,451
Interest earned on other investments	2011-12-31	$36,847
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$3,151
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$61,774
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$61,774
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$1
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$2,411,467
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$1,780,992
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-220,301
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$311,344
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$203,039
Contract administrator fees	2011-12-31	$8,918
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	TYLER SIMMS & ST. SAUVEUR
Accountancy firm EIN	2011-12-31	020476956
2010 : ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT 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	$62,021
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$2,816
Total income from all sources (including contributions)	2010-12-31	$2,310,900
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$93,337
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$84,786
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$1,752,483
Value of total assets at end of year	2010-12-31	$6,795,858
Value of total assets at beginning of year	2010-12-31	$4,519,090
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$8,551
Total interest from all sources	2010-12-31	$1,410
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$1,432,159
Participant contributions at end of year	2010-12-31	$76,871
Participant contributions at beginning of year	2010-12-31	$22,651
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$3,199
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$2,816
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$62,021
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$2,816
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	$2,217,563
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$6,733,837
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$4,516,274
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$4,873,022
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$3,388,713
Interest on participant loans	2010-12-31	$1,410
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$61,774
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$2,952
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$2,952
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$1,780,992
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$1,101,958
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$557,007
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$320,324
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$84,786
Contract administrator fees	2010-12-31	$8,551
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	TYLER SIMMS & ST. SAUVEUR
Accountancy firm EIN	2010-12-31	020476956
2009 : ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for ANDROSCOGGIN VALLEY HOSPITAL 403(B) RETIREMENT PLAN

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

Insurance Providers Used on plan

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

Policy contract number

892565-007

Policy instance

Insurance contract or identification number	892565-007
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-10-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

892565-007

Policy instance

Insurance contract or identification number	892565-007
Number of Individuals Covered	327
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

892565-007

Policy instance

Insurance contract or identification number	892565-007
Number of Individuals Covered	334
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

892565-007

Policy instance

Insurance contract or identification number	892565-007
Number of Individuals Covered	344
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

892565-007

Policy instance

Insurance contract or identification number	892565-007
Number of Individuals Covered	378
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

892565-007

Policy instance

Insurance contract or identification number	892565-007
Number of Individuals Covered	380
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

892565-007

Policy instance

Insurance contract or identification number	892565-007
Number of Individuals Covered	369
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ANDROSCOGGIN VALLEY HOSPITAL, INC.
Employer identification number (EIN):	020280367
NAIC Classification:	622000
NAIC Description:	Hospitals