401k Plan data: CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN plan

CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 401k Plan overview

Plan Name	CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN
Plan identification number	011

CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

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

Company Name: WELLSPAN CHAMBERSBURG HOSPITAL

Employer identification number (EIN): 230465970

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
011 2020-01-01
011 2019-01-01
011 2018-01-01
011 2017-01-01 KIMBERLY RZOMP KIMBERLY RZOMP 2018-10-15

Plan Statistics for CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN

401k plan membership statisitcs for CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN

Measure Date Value
2020: CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,845
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,629
Number of retired or separated participants receiving benefits 2020-01-01 3
Number of other retired or separated participants entitled to future benefits 2020-01-01 362
Total of all active and inactive participants 2020-01-01 1,994
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 2
Total participants 2020-01-01 1,996
Number of participants with account balances 2020-01-01 1,357
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,883
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,549
Number of retired or separated participants receiving benefits 2019-01-01 4
Number of other retired or separated participants entitled to future benefits 2019-01-01 291
Total of all active and inactive participants 2019-01-01 1,844
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 1
Total participants 2019-01-01 1,845
Number of participants with account balances 2019-01-01 1,325
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,163
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,639
Number of retired or separated participants receiving benefits 2018-01-01 5
Number of other retired or separated participants entitled to future benefits 2018-01-01 232
Total of all active and inactive participants 2018-01-01 1,876
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 7
Total participants 2018-01-01 1,883
Number of participants with account balances 2018-01-01 1,248
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,049
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 963
Number of retired or separated participants receiving benefits 2017-01-01 3
Number of other retired or separated participants entitled to future benefits 2017-01-01 197
Total of all active and inactive participants 2017-01-01 1,163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 1,163
Number of participants with account balances 2017-01-01 1,151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0

Measure	Date	Value
2020: CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,845
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,629
Number of retired or separated participants receiving benefits	2020-01-01	3
Number of other retired or separated participants entitled to future benefits	2020-01-01	362
Total of all active and inactive participants	2020-01-01	1,994
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	2
Total participants	2020-01-01	1,996
Number of participants with account balances	2020-01-01	1,357
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,883
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,549
Number of retired or separated participants receiving benefits	2019-01-01	4
Number of other retired or separated participants entitled to future benefits	2019-01-01	291
Total of all active and inactive participants	2019-01-01	1,844
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	1
Total participants	2019-01-01	1,845
Number of participants with account balances	2019-01-01	1,325
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,163
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,639
Number of retired or separated participants receiving benefits	2018-01-01	5
Number of other retired or separated participants entitled to future benefits	2018-01-01	232
Total of all active and inactive participants	2018-01-01	1,876
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	7
Total participants	2018-01-01	1,883
Number of participants with account balances	2018-01-01	1,248
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,049
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	963
Number of retired or separated participants receiving benefits	2017-01-01	3
Number of other retired or separated participants entitled to future benefits	2017-01-01	197
Total of all active and inactive participants	2017-01-01	1,163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	1,163
Number of participants with account balances	2017-01-01	1,151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0

Financial Data on CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN

Measure	Date	Value
2020 : CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$12,831,165
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$2,269,647
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$2,242,031
Expenses. Certain deemed distributions of participant loans	2020-12-31	$23,517
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$4,626,530
Value of total assets at end of year	2020-12-31	$62,337,803
Value of total assets at beginning of year	2020-12-31	$51,776,285
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$4,099
Total interest from all sources	2020-12-31	$187,331
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$3,830,494
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$3,830,494
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$4,557,723
Participant contributions at end of year	2020-12-31	$949,812
Participant contributions at beginning of year	2020-12-31	$1,002,310
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$68,807
Other income not declared elsewhere	2020-12-31	$4,650
Administrative expenses (other) incurred	2020-12-31	$4,099
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	$10,561,518
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$62,337,803
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$51,776,285
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	$52,157,019
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$42,165,553
Interest on participant loans	2020-12-31	$47,195
Interest earned on other investments	2020-12-31	$140,136
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$9,230,972
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$8,608,422
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$4,176,942
Net investment gain/loss from pooled separate accounts	2020-12-31	$5,218
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	$2,242,031
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	SMITH ELLIOTT KEARNS & COMPANY
Accountancy firm EIN	2020-12-31	520783935
2019 : CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$12,318,437
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$1,763,372
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$1,739,328
Expenses. Certain deemed distributions of participant loans	2019-12-31	$17,129
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$4,337,685
Value of total assets at end of year	2019-12-31	$51,776,285
Value of total assets at beginning of year	2019-12-31	$41,221,220
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$6,915
Total interest from all sources	2019-12-31	$187,289
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$3,408,260
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$3,408,260
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$4,024,380
Participant contributions at end of year	2019-12-31	$1,002,310
Participant contributions at beginning of year	2019-12-31	$944,813
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$313,305
Other income not declared elsewhere	2019-12-31	$1,718
Administrative expenses (other) incurred	2019-12-31	$6,915
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	$10,555,065
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$51,776,285
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$41,221,220
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	$42,165,553
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$32,230,533
Interest on participant loans	2019-12-31	$46,372
Interest earned on other investments	2019-12-31	$140,917
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$8,608,422
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$8,045,874
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$4,377,671
Net investment gain/loss from pooled separate accounts	2019-12-31	$5,814
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,739,328
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	SMITH ELLIOTT KEARNS & COMPANY
Accountancy firm EIN	2019-12-31	520783935
2018 : CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$1,479,842
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$1,203,606
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,185,864
Expenses. Certain deemed distributions of participant loans	2018-12-31	$11,741
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$3,882,016
Value of total assets at end of year	2018-12-31	$41,221,220
Value of total assets at beginning of year	2018-12-31	$40,944,984
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$6,001
Total interest from all sources	2018-12-31	$241,489
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$2,306,013
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$2,306,013
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$3,702,300
Participant contributions at end of year	2018-12-31	$944,813
Participant contributions at beginning of year	2018-12-31	$837,915
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$179,716
Other income not declared elsewhere	2018-12-31	$-3,163
Administrative expenses (other) incurred	2018-12-31	$6,001
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	$276,236
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$41,221,220
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$40,944,984
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$32,230,533
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$32,458,523
Interest on participant loans	2018-12-31	$45,502
Interest earned on other investments	2018-12-31	$195,987
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$8,045,874
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$7,648,546
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-4,944,156
Net investment gain/loss from pooled separate accounts	2018-12-31	$-2,357
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	$1,185,864
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	SMITH ELLIOTT KEARNS & COMPANY
Accountancy firm EIN	2018-12-31	520783935
2017 : CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$9,114,832
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$1,802,577
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$1,792,853
Expenses. Certain deemed distributions of participant loans	2017-12-31	$3,913
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$3,739,709
Value of total assets at end of year	2017-12-31	$40,944,984
Value of total assets at beginning of year	2017-12-31	$33,632,729
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$5,811
Total interest from all sources	2017-12-31	$264,383
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$1,380,755
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$1,380,755
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$3,468,931
Participant contributions at end of year	2017-12-31	$837,915
Participant contributions at beginning of year	2017-12-31	$663,169
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$270,778
Other income not declared elsewhere	2017-12-31	$199
Administrative expenses (other) incurred	2017-12-31	$5,811
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	$7,312,255
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$40,944,984
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$33,632,729
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	$32,458,523
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$25,618,393
Interest on participant loans	2017-12-31	$40,910
Interest earned on other investments	2017-12-31	$223,473
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$7,648,546
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$7,351,167
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$3,016,541
Net investment gain/loss from pooled separate accounts	2017-12-31	$713,245
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	$1,792,853
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	CHARLES L. STRAUSBAUGH, CPA, PC
Accountancy firm EIN	2017-12-31	251877259

Form 5500 Responses for CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN

2020: CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: CHAMBERSBURG HOSPITAL BARGAINING 403(B) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	Yes
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

Insurance Providers Used on plan

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

Policy contract number

664044

Policy instance

Insurance contract or identification number	664044
Number of Individuals Covered	1996
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

666158

Policy instance

Insurance contract or identification number	666158
Number of Individuals Covered	1
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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?	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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

664044

Policy instance

Insurance contract or identification number	664044
Number of Individuals Covered	1845
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

666158

Policy instance

Insurance contract or identification number	666158
Number of Individuals Covered	1
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	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?	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

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

Policy contract number

664044

Policy instance

Insurance contract or identification number	664044
Number of Individuals Covered	1883
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

664044

Policy instance

Insurance contract or identification number	664044
Number of Individuals Covered	1163
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
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?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

VFZ158

Policy instance

Insurance contract or identification number	VFZ158
Number of Individuals Covered	1
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $17,012
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,012
Insurance broker organization code?	3
Insurance broker name	LPL FINANCIAL CORPORATION

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