BUTLER MEMORIAL HOSPITAL 403(B) PLAN 401k Plan overview

Plan Name	BUTLER MEMORIAL HOSPITAL 403(B) PLAN
Plan identification number	007

BUTLER MEMORIAL HOSPITAL 403(B) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met. Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met. Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities. 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. Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

BUTLER HEALTHCARE PROVIDERS has sponsored the creation of one or more 401k plans.

Company Name:	BUTLER HEALTHCARE PROVIDERS
Employer identification number (EIN):	250965274
NAIC Classification:	622000
NAIC Description:	Hospitals

Additional information about BUTLER HEALTHCARE PROVIDERS

Jurisdiction of Incorporation:	COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE
Incorporation Date:
Company Identification Number:	628293

More information about BUTLER HEALTHCARE PROVIDERS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BUTLER MEMORIAL HOSPITAL 403(B) PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
007	2022-01-01
007	2021-01-01	ERIC HUSS	2022-10-17	ERIC HUSS	2022-10-17
007	2020-01-01	ERIC HUSS	2021-10-15	ERIC HUSS	2021-10-15
007	2019-01-01	THOMAS GENEVRO	2020-10-13	THOMAS GENEVRO	2020-10-13
007	2018-01-01	THOMAS GENEVRO	2019-10-14	THOMAS GENEVRO	2019-10-14
007	2017-01-01
007	2016-01-01
007	2015-01-01
007	2014-01-01
007	2013-01-01
007	2012-01-01	ANNE B. KREBS		ANNE B. KREBS	2013-07-17
007	2011-01-01	ANNE B. KREBS		ANNE B. KREBS	2013-07-17
007	2010-01-01	ANNE B. KREBS
007	2009-01-01	ANNE B KREBS

Plan Statistics for BUTLER MEMORIAL HOSPITAL 403(B) PLAN

401k plan membership statisitcs for BUTLER MEMORIAL HOSPITAL 403(B) PLAN

Measure	Date	Value
2022: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	2,366
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,551
Number of retired or separated participants receiving benefits	2022-01-01	1
Number of other retired or separated participants entitled to future benefits	2022-01-01	13
Total of all active and inactive participants	2022-01-01	1,565
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	1,565
Number of participants with account balances	2022-01-01	1,009
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	91
2021: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	2,253
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,969
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	397
Total of all active and inactive participants	2021-01-01	2,366
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	2,366
Number of participants with account balances	2021-01-01	1,491
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	11
2020: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	2,323
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,925
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	340
Total of all active and inactive participants	2020-01-01	2,265
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	2,265
Number of participants with account balances	2020-01-01	1,439
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	9
2019: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	2,217
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	2,032
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	259
Total of all active and inactive participants	2019-01-01	2,291
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	2,291
Number of participants with account balances	2019-01-01	1,395
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	7
2018: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	2,107
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,910
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	260
Total of all active and inactive participants	2018-01-01	2,170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	2,170
Number of participants with account balances	2018-01-01	1,349
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	7
2017: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	2,019
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,835
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	253
Total of all active and inactive participants	2017-01-01	2,088
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	2,088
Number of participants with account balances	2017-01-01	1,293
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	3
2016: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,840
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,588
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	236
Total of all active and inactive participants	2016-01-01	1,824
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	1,824
Number of participants with account balances	2016-01-01	1,261
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	1
2015: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,996
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,820
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	220
Total of all active and inactive participants	2015-01-01	2,040
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	2,040
Number of participants with account balances	2015-01-01	1,237
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	2
2014: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2,023
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,767
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	207
Total of all active and inactive participants	2014-01-01	1,974
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	1,974
Number of participants with account balances	2014-01-01	1,197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	2
2013: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	2,017
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,768
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	255
Total of all active and inactive participants	2013-01-01	2,023
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	2,023
Number of participants with account balances	2013-01-01	1,229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,933
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,730
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	268
Total of all active and inactive participants	2012-01-01	1,998
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	1,999
Number of participants with account balances	2012-01-01	1,099
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,994
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,706
Number of retired or separated participants receiving benefits	2011-01-01	7
Number of other retired or separated participants entitled to future benefits	2011-01-01	219
Total of all active and inactive participants	2011-01-01	1,932
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	1,933
Number of participants with account balances	2011-01-01	1,067
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	4
2010: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,823
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,780
Number of retired or separated participants receiving benefits	2010-01-01	8
Number of other retired or separated participants entitled to future benefits	2010-01-01	195
Total of all active and inactive participants	2010-01-01	1,983
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	1
Total participants	2010-01-01	1,984
Number of participants with account balances	2010-01-01	1,066
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	1
2009: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,902
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,637
Number of retired or separated participants receiving benefits	2009-01-01	30
Number of other retired or separated participants entitled to future benefits	2009-01-01	157
Total of all active and inactive participants	2009-01-01	1,824
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	1,824
Number of participants with account balances	2009-01-01	992
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on BUTLER MEMORIAL HOSPITAL 403(B) PLAN

Measure	Date	Value
2022 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2022 401k financial data
Total income from all sources (including contributions)	2022-12-31	$-7,768,206
Total of all expenses incurred	2022-12-31	$6,379,695
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$6,063,300
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$7,848,292
Value of total assets at end of year	2022-12-31	$85,367,268
Value of total assets at beginning of year	2022-12-31	$99,515,169
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$316,395
Total interest from all sources	2022-12-31	$51,557
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$-133,404
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$-133,404
Administrative expenses professional fees incurred	2022-12-31	$292,035
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$5,762,698
Participant contributions at end of year	2022-12-31	$1,029,713
Participant contributions at beginning of year	2022-12-31	$1,098,957
Participant contributions at end of year	2022-12-31	$213,655
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$1,161,294
Total non interest bearing cash at beginning of year	2022-12-31	$157
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-14,147,901
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$85,367,268
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$99,515,169
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$2,061
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$75,359,898
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$89,423,988
Value of interest in pooled separate accounts at end of year	2022-12-31	$2,409,531
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$3,086,027
Interest on participant loans	2022-12-31	$51,557
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$5,430,171
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$5,000,587
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-15,534,651
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$924,300
Employer contributions (assets) at end of year	2022-12-31	$924,300
Employer contributions (assets) at beginning of year	2022-12-31	$905,453
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$6,063,300
Contract administrator fees	2022-12-31	$22,299
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	FORVIS, LLP
Accountancy firm EIN	2022-12-31	440160260
2021 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-12-31	$18,801,539
Total of all expenses incurred	2021-12-31	$6,323,546
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$5,976,533
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$6,711,109
Value of total assets at end of year	2021-12-31	$99,515,169
Value of total assets at beginning of year	2021-12-31	$87,037,176
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$347,013
Total interest from all sources	2021-12-31	$63,161
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$193,787
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$193,787
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$100,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$5,454,228
Participant contributions at end of year	2021-12-31	$1,098,957
Participant contributions at beginning of year	2021-12-31	$1,065,928
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$351,428
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2021-12-31	$155,307
Administrative expenses (other) incurred	2021-12-31	$5,057
Total non interest bearing cash at end of year	2021-12-31	$157
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$12,477,993
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$99,515,169
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$87,037,176
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$1,870
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$89,423,988
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$77,012,366
Value of interest in pooled separate accounts at end of year	2021-12-31	$3,086,027
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$2,762,119
Interest on participant loans	2021-12-31	$62,313
Interest earned on other investments	2021-12-31	$848
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$5,000,587
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$5,346,676
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$11,833,482
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$905,453
Employer contributions (assets) at end of year	2021-12-31	$905,453
Employer contributions (assets) at beginning of year	2021-12-31	$850,087
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$5,821,226
Contract administrator fees	2021-12-31	$340,086
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	FORVIS, LLP
Accountancy firm EIN	2021-12-31	440160260
2020 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total transfer of assets to this plan	2020-12-31	$73,016
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	$17,558,070
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$4,009,461
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$3,715,189
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$6,626,173
Value of total assets at end of year	2020-12-31	$87,037,176
Value of total assets at beginning of year	2020-12-31	$73,415,551
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$294,272
Total interest from all sources	2020-12-31	$90,515
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$2,980,233
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	$2,980,233
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$5,007,554
Participant contributions at end of year	2020-12-31	$1,065,928
Participant contributions at beginning of year	2020-12-31	$910,513
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$768,532
Administrative expenses (other) incurred	2020-12-31	$47,097
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	$13,548,609
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$87,037,176
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$73,415,551
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
Investment advisory and management fees	2020-12-31	$135,593
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$77,012,366
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$64,792,221
Value of interest in pooled separate accounts at end of year	2020-12-31	$2,762,119
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$2,286,043
Interest on participant loans	2020-12-31	$61,322
Interest earned on other investments	2020-12-31	$29,193
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$5,346,676
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$4,598,555
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$7,757,694
Net investment gain or loss from common/collective trusts	2020-12-31	$103,455
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$850,087
Employer contributions (assets) at end of year	2020-12-31	$850,087
Employer contributions (assets) at beginning of year	2020-12-31	$828,219
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$3,715,189
Contract administrator fees	2020-12-31	$111,582
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	BLUE & CO.
Accountancy firm EIN	2020-12-31	351178661
2019 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total transfer of assets to this plan	2019-12-31	$251,747
Total transfer of assets from this plan	2019-12-31	$28,330
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	$18,750,457
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$3,784,097
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$3,520,181
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$6,107,439
Value of total assets at end of year	2019-12-31	$73,415,551
Value of total assets at beginning of year	2019-12-31	$58,225,774
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$263,916
Total interest from all sources	2019-12-31	$88,058
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$3,122,196
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	$3,122,196
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$4,944,331
Participant contributions at end of year	2019-12-31	$910,513
Participant contributions at beginning of year	2019-12-31	$979,628
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$334,889
Administrative expenses (other) incurred	2019-12-31	$44,551
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	$14,966,360
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$73,415,551
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$58,225,774
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
Investment advisory and management fees	2019-12-31	$123,393
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$64,792,221
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$49,847,541
Value of interest in pooled separate accounts at end of year	2019-12-31	$2,286,043
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$2,587,911
Income. Interest from loans (other than to participants)	2019-12-31	$63,224
Interest earned on other investments	2019-12-31	$24,834
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$4,598,555
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$4,019,382
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$9,357,492
Net investment gain or loss from common/collective trusts	2019-12-31	$75,272
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$828,219
Employer contributions (assets) at end of year	2019-12-31	$828,219
Employer contributions (assets) at beginning of year	2019-12-31	$791,312
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$3,520,181
Contract administrator fees	2019-12-31	$95,972
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	BLUE & CO.
Accountancy firm EIN	2019-12-31	351178661
2018 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total transfer of assets to this plan	2018-12-31	$100,020
Total transfer of assets from this plan	2018-12-31	$102,319
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	$2,494,368
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$7,715,094
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$7,398,758
Expenses. Certain deemed distributions of participant loans	2018-12-31	$62,173
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$6,066,796
Value of total assets at end of year	2018-12-31	$58,225,774
Value of total assets at beginning of year	2018-12-31	$63,448,799
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$254,163
Total interest from all sources	2018-12-31	$164,665
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$3,305,151
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	$3,305,151
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$4,572,341
Participant contributions at end of year	2018-12-31	$979,628
Participant contributions at beginning of year	2018-12-31	$989,151
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$702,378
Administrative expenses (other) incurred	2018-12-31	$43,242
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	$-5,220,726
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$58,225,774
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$63,448,799
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
Investment advisory and management fees	2018-12-31	$121,124
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$49,847,541
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$56,713,599
Value of interest in pooled separate accounts at end of year	2018-12-31	$2,587,911
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$2,860,887
Interest on participant loans	2018-12-31	$61,401
Interest earned on other investments	2018-12-31	$103,264
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$4,019,382
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$2,144,655
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-7,110,621
Net investment gain/loss from pooled separate accounts	2018-12-31	$68,377
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$792,077
Employer contributions (assets) at end of year	2018-12-31	$791,312
Employer contributions (assets) at beginning of year	2018-12-31	$740,507
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$7,398,758
Contract administrator fees	2018-12-31	$89,797
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	BLUE & CO.
Accountancy firm EIN	2018-12-31	351178661
2017 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total transfer of assets to this plan	2017-12-31	$6,884
Total transfer of assets from this plan	2017-12-31	$58,908
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	$13,784,002
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$3,598,405
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$3,345,831
Expenses. Certain deemed distributions of participant loans	2017-12-31	$8,746
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$5,404,677
Value of total assets at end of year	2017-12-31	$63,448,799
Value of total assets at beginning of year	2017-12-31	$53,315,226
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$243,828
Total interest from all sources	2017-12-31	$46,757
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$4,214,918
Participant contributions at end of year	2017-12-31	$989,151
Participant contributions at beginning of year	2017-12-31	$732,307
Participant contributions at beginning of year	2017-12-31	$155,981
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$449,252
Other income not declared elsewhere	2017-12-31	$652
Administrative expenses (other) incurred	2017-12-31	$37,994
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	$10,185,597
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$63,448,799
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$53,315,226
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
Investment advisory and management fees	2017-12-31	$127,130
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$56,713,599
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$47,039,570
Value of interest in pooled separate accounts at end of year	2017-12-31	$2,860,887
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$2,564,003
Interest on participant loans	2017-12-31	$46,757
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$2,144,655
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$2,122,554
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$7,867,852
Net investment gain/loss from pooled separate accounts	2017-12-31	$464,064
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$740,507
Employer contributions (assets) at end of year	2017-12-31	$740,507
Employer contributions (assets) at beginning of year	2017-12-31	$700,811
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$3,345,831
Contract administrator fees	2017-12-31	$78,704
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	BLUE & CO.
Accountancy firm EIN	2017-12-31	351178661
2016 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total transfer of assets from this plan	2016-12-31	$21,972
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	$8,377,338
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$3,565,865
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$3,223,913
Value of total corrective distributions	2016-12-31	$117,365
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$4,887,510
Value of total assets at end of year	2016-12-31	$53,315,226
Value of total assets at beginning of year	2016-12-31	$48,525,725
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$224,587
Total interest from all sources	2016-12-31	$66,787
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
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	$3,955,351
Participant contributions at end of year	2016-12-31	$732,307
Participant contributions at beginning of year	2016-12-31	$761,342
Participant contributions at end of year	2016-12-31	$155,981
Participant contributions at beginning of year	2016-12-31	$142,537
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$231,348
Other income not declared elsewhere	2016-12-31	$189
Administrative expenses (other) incurred	2016-12-31	$20,194
Total non interest bearing cash at beginning of year	2016-12-31	$68,774
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	$4,811,473
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$53,315,226
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$48,525,725
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	$129,941
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$47,039,570
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$39,713,374
Value of interest in pooled separate accounts at end of year	2016-12-31	$2,564,003
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$2,729,079
Interest on participant loans	2016-12-31	$65,842
Interest earned on other investments	2016-12-31	$945
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$1,874,356
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$1,874,356
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$2,122,554
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$2,583,087
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$3,212,062
Net investment gain/loss from pooled separate accounts	2016-12-31	$210,790
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	$700,811
Employer contributions (assets) at end of year	2016-12-31	$700,811
Employer contributions (assets) at beginning of year	2016-12-31	$653,176
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$3,223,913
Contract administrator fees	2016-12-31	$74,452
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	ARNETT CARBIS TOOTHMAN, LLP
Accountancy firm EIN	2016-12-31	550486667
2015 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2015 401k financial data
Total income from all sources (including contributions)	2015-12-31	$4,351,687
Total of all expenses incurred	2015-12-31	$2,905,705
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$2,573,321
Expenses. Certain deemed distributions of participant loans	2015-12-31	$23,527
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$4,778,298
Value of total assets at end of year	2015-12-31	$48,525,725
Value of total assets at beginning of year	2015-12-31	$47,079,743
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$308,857
Total interest from all sources	2015-12-31	$35,404
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$3,708,786
Participant contributions at end of year	2015-12-31	$761,342
Participant contributions at beginning of year	2015-12-31	$713,235
Participant contributions at end of year	2015-12-31	$142,537
Participant contributions at beginning of year	2015-12-31	$123,466
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$418,151
Other income not declared elsewhere	2015-12-31	$68,774
Administrative expenses (other) incurred	2015-12-31	$7,450
Total non interest bearing cash at end of year	2015-12-31	$68,774
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$1,445,982
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$48,525,725
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$47,079,743
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	$133,822
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$39,713,374
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$38,300,326
Value of interest in pooled separate accounts at end of year	2015-12-31	$2,729,079
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$2,952,336
Interest on participant loans	2015-12-31	$35,337
Interest earned on other investments	2015-12-31	$67
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$1,874,356
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$1,806,670
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$1,806,670
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$2,583,087
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$2,549,359
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-508,134
Net investment gain/loss from pooled separate accounts	2015-12-31	$-22,655
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	$651,361
Employer contributions (assets) at end of year	2015-12-31	$653,176
Employer contributions (assets) at beginning of year	2015-12-31	$634,351
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$2,573,321
Contract administrator fees	2015-12-31	$167,585
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	ARNETT CARBIS TOOTHMAN, LLP
Accountancy firm EIN	2015-12-31	550486667
2014 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2014 401k financial data
Total income from all sources (including contributions)	2014-12-31	$6,994,917
Total of all expenses incurred	2014-12-31	$3,059,231
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$2,692,494
Expenses. Certain deemed distributions of participant loans	2014-12-31	$59,704
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$4,455,584
Value of total assets at end of year	2014-12-31	$47,079,743
Value of total assets at beginning of year	2014-12-31	$43,144,057
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$307,033
Total interest from all sources	2014-12-31	$32,305
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$3,553,854
Participant contributions at end of year	2014-12-31	$713,235
Participant contributions at beginning of year	2014-12-31	$644,943
Participant contributions at end of year	2014-12-31	$123,466
Participant contributions at beginning of year	2014-12-31	$100
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$267,379
Administrative expenses (other) incurred	2014-12-31	$10,063
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	$3,935,686
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$47,079,743
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$43,144,057
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	$122,173
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$38,300,326
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$34,315,566
Value of interest in pooled separate accounts at end of year	2014-12-31	$2,952,336
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$3,084,355
Interest on participant loans	2014-12-31	$32,129
Interest earned on other investments	2014-12-31	$176
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$1,806,670
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$2,010,514
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$2,010,514
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$2,549,359
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$2,524,625
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$2,426,412
Net investment gain/loss from pooled separate accounts	2014-12-31	$80,616
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	$634,351
Employer contributions (assets) at end of year	2014-12-31	$634,351
Employer contributions (assets) at beginning of year	2014-12-31	$563,954
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$2,692,494
Contract administrator fees	2014-12-31	$174,797
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	ARNETT CARBIS TOOTHMAN, LLP
Accountancy firm EIN	2014-12-31	550486667
2013 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2013 401k financial data
Total income from all sources (including contributions)	2013-12-31	$10,695,391
Total of all expenses incurred	2013-12-31	$3,222,196
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$2,912,124
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$4,072,500
Value of total assets at end of year	2013-12-31	$43,144,057
Value of total assets at beginning of year	2013-12-31	$35,670,862
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$310,072
Total interest from all sources	2013-12-31	$70,081
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$3,138,204
Participant contributions at end of year	2013-12-31	$644,943
Participant contributions at beginning of year	2013-12-31	$504,804
Participant contributions at end of year	2013-12-31	$100
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$355,626
Administrative expenses (other) incurred	2013-12-31	$7,425
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	$7,473,195
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$43,144,057
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$35,670,862
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	$23,640
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$34,315,566
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$27,400,234
Value of interest in pooled separate accounts at end of year	2013-12-31	$3,084,355
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$2,670,833
Interest on participant loans	2013-12-31	$24,613
Interest earned on other investments	2013-12-31	$45,468
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$2,010,514
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$2,080,679
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$2,080,679
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$2,524,625
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$2,514,790
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$6,501,139
Net investment gain/loss from pooled separate accounts	2013-12-31	$51,671
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	$578,670
Employer contributions (assets) at end of year	2013-12-31	$563,954
Employer contributions (assets) at beginning of year	2013-12-31	$499,522
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$2,912,124
Contract administrator fees	2013-12-31	$279,007
Assets. Value of buildings and other operty used in plan operation at beginning of year	2013-12-31	$0
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	CARBIS WALKER
Accountancy firm EIN	2013-12-31	250988255
2012 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2012 401k financial data
Total transfer of assets from this plan	2012-12-31	$23,507
Total income from all sources (including contributions)	2012-12-31	$7,088,008
Total of all expenses incurred	2012-12-31	$2,205,092
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$1,909,465
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$3,573,429
Value of total assets at end of year	2012-12-31	$35,670,862
Value of total assets at beginning of year	2012-12-31	$30,811,453
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$295,627
Total interest from all sources	2012-12-31	$112,992
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
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	$2,837,045
Participant contributions at end of year	2012-12-31	$504,804
Participant contributions at beginning of year	2012-12-31	$433,028
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$174,839
Administrative expenses (other) incurred	2012-12-31	$7,790
Total non interest bearing cash at beginning of year	2012-12-31	$7
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	$62,023
Value of net income/loss	2012-12-31	$4,882,916
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$35,670,862
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$30,811,453
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	$19,876
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$27,400,234
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$22,377,770
Value of interest in pooled separate accounts at end of year	2012-12-31	$2,670,833
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$2,638,829
Interest on participant loans	2012-12-31	$18,826
Interest earned on other investments	2012-12-31	$94,166
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$2,080,679
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$2,005,495
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$2,005,495
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$2,514,790
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$2,866,543
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$3,360,160
Net investment gain/loss from pooled separate accounts	2012-12-31	$41,427
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	$499,522
Employer contributions (assets) at end of year	2012-12-31	$499,522
Employer contributions (assets) at beginning of year	2012-12-31	$489,781
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$1,909,465
Contract administrator fees	2012-12-31	$267,961
Assets. Value of buildings and other operty used in plan operation at end of year	2012-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2012-12-31	$0
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	CARBIS WALKER
Accountancy firm EIN	2012-12-31	250988255
2011 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets to this plan	2011-12-31	$11,460
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$3,151,950
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$2,733,079
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$2,465,922
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$3,698,786
Value of total assets at end of year	2011-12-31	$30,145,759
Value of total assets at beginning of year	2011-12-31	$29,715,428
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$267,157
Total interest from all sources	2011-12-31	$105,235
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
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	$2,831,071
Participant contributions at end of year	2011-12-31	$387,459
Participant contributions at beginning of year	2011-12-31	$311,475
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$378,104
Other income not declared elsewhere	2011-12-31	$665,694
Administrative expenses (other) incurred	2011-12-31	$6,935
Total non interest bearing cash at end of year	2011-12-31	$7
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	$418,871
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$30,145,759
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$29,715,428
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
Investment advisory and management fees	2011-12-31	$18,653
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$21,994,549
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$23,935,070
Value of interest in pooled separate accounts at end of year	2011-12-31	$2,638,829
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$0
Interest on participant loans	2011-12-31	$14,901
Interest earned on other investments	2011-12-31	$90,334
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$2,005,495
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$2,288,309
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$2,288,309
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$2,629,639
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$2,691,773
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-592,671
Net investment gain/loss from pooled separate accounts	2011-12-31	$-59,400
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	$489,611
Employer contributions (assets) at end of year	2011-12-31	$489,781
Employer contributions (assets) at beginning of year	2011-12-31	$488,801
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$2,465,922
Contract administrator fees	2011-12-31	$241,569
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	CARBIS WALKER
Accountancy firm EIN	2011-12-31	250988255
2010 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$6,353,953
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$1,087,795
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$3,449,466
Value of total assets at end of year	2010-12-31	$29,715,428
Value of total assets at beginning of year	2010-12-31	$24,449,270
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,087,795
Total interest from all sources	2010-12-31	$138,516
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
Administrative expenses professional fees incurred	2010-12-31	$864,002
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	$2,717,661
Participant contributions at end of year	2010-12-31	$311,475
Participant contributions at beginning of year	2010-12-31	$226,381
Participant contributions at end of year	2010-12-31	$0
Participant contributions at beginning of year	2010-12-31	$190
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$243,004
Administrative expenses (other) incurred	2010-12-31	$2,510
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	$5,266,158
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$29,715,428
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$24,449,270
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
Investment advisory and management fees	2010-12-31	$14,515
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$23,935,070
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$18,765,890
Interest on participant loans	2010-12-31	$12,240
Interest earned on other investments	2010-12-31	$126,276
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$2,288,309
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$2,298,279
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$2,298,279
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$2,691,773
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$2,708,372
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$2,765,971
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	$488,801
Employer contributions (assets) at end of year	2010-12-31	$488,801
Employer contributions (assets) at beginning of year	2010-12-31	$450,158
Contract administrator fees	2010-12-31	$206,768
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	PARENTEBEARD LLC
Accountancy firm EIN	2010-12-31	232932984
2009 : BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for BUTLER MEMORIAL HOSPITAL 403(B) PLAN

2022: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
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
2010: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: BUTLER MEMORIAL HOSPITAL 403(B) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
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

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number	GAP-B2-JF4G
Policy instance	3
Insurance contract or identification number GAP-B2-JF4G Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	85188-01
Policy instance	1
Insurance contract or identification number 85188-01 Number of Individuals Covered 91 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	GP02071
Policy instance	2
Insurance contract or identification number GP02071 Number of Individuals Covered 6 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007695-H
Policy instance	9
Insurance contract or identification number 007695-H Number of Individuals Covered 1 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VC2057
Policy instance	4
Insurance contract or identification number VC2057 Number of Individuals Covered 9 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $496 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Commission paid to Insurance Broker USD $496 Insurance broker organization code? 3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	BF58
Policy instance	5
Insurance contract or identification number BF58 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number	077619 001
Policy instance	6
Insurance contract or identification number 077619 001 Number of Individuals Covered 3 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	311773
Policy instance	7
Insurance contract or identification number 311773 Number of Individuals Covered 2 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007653-C
Policy instance	8
Insurance contract or identification number 007653-C Number of Individuals Covered 5 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	85188-01
Policy instance	1
Insurance contract or identification number 85188-01 Number of Individuals Covered 95 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	GP02071
Policy instance	2
Insurance contract or identification number GP02071 Number of Individuals Covered 7 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number	GAP-B2-JF4G
Policy instance	3
Insurance contract or identification number GAP-B2-JF4G Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VC2057
Policy instance	4
Insurance contract or identification number VC2057 Number of Individuals Covered 10 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $493 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $493 Insurance broker organization code? 3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	BF58
Policy instance	5
Insurance contract or identification number BF58 Number of Individuals Covered 8 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	311773
Policy instance	7
Insurance contract or identification number 311773 Number of Individuals Covered 2 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007695-H
Policy instance	8
Insurance contract or identification number 007695-H Number of Individuals Covered 1 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007653-C
Policy instance	9
Insurance contract or identification number 007653-C Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number	077619 001
Policy instance	6
Insurance contract or identification number 077619 001 Number of Individuals Covered 3 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	85188-01
Policy instance	1
Insurance contract or identification number 85188-01 Number of Individuals Covered 102 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	GP02071
Policy instance	2
Insurance contract or identification number GP02071 Number of Individuals Covered 10 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007653-C
Policy instance	9
Insurance contract or identification number 007653-C 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 Contracts With Unallocated Funds Deposit Administration 1 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VC2057
Policy instance	4
Insurance contract or identification number VC2057 Number of Individuals Covered 11 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	BF58
Policy instance	5
Insurance contract or identification number BF58 Number of Individuals Covered 8 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number	077619 001
Policy instance	6
Insurance contract or identification number 077619 001 Number of Individuals Covered 3 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	311773
Policy instance	7
Insurance contract or identification number 311773 Number of Individuals Covered 2 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 unallocated funds for contracts of type guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007695-H
Policy instance	8
Insurance contract or identification number 007695-H 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number	GAP-B2-JF4G
Policy instance	3
Insurance contract or identification number GAP-B2-JF4G 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 unallocated funds for contracts of type guaranteed investment? Yes
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	311773
Policy instance	7
Insurance contract or identification number 311773 Number of Individuals Covered 2 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 unallocated funds for contracts of type guaranteed investment? Yes
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number	077619 001
Policy instance	6
Insurance contract or identification number 077619 001 Number of Individuals Covered 3 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	BF58
Policy instance	5
Insurance contract or identification number BF58 Number of Individuals Covered 9 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VC2057
Policy instance	4
Insurance contract or identification number VC2057 Number of Individuals Covered 11 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Insurance broker organization code? 3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number	GAP-B2-JF4G
Policy instance	3
Insurance contract or identification number GAP-B2-JF4G Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	GP02071
Policy instance	2
Insurance contract or identification number GP02071 Number of Individuals Covered 10 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	85188-01
Policy instance	1
Insurance contract or identification number 85188-01 Number of Individuals Covered 107 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007695-H
Policy instance	8
Insurance contract or identification number 007695-H 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007653-C
Policy instance	9
Insurance contract or identification number 007653-C Number of Individuals Covered 0 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 Contracts With Unallocated Funds Deposit Administration 1
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	85188-01
Policy instance	1
Insurance contract or identification number 85188-01 Number of Individuals Covered 110 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007653-C
Policy instance	8
Insurance contract or identification number 007653-C Number of Individuals Covered 0 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007695-H
Policy instance	7
Insurance contract or identification number 007695-H Number of Individuals Covered 1 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	311773
Policy instance	6
Insurance contract or identification number 311773 Number of Individuals Covered 2 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 unallocated funds for contracts of type guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number	077619 001
Policy instance	5
Insurance contract or identification number 077619 001 Number of Individuals Covered 3 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	BF58
Policy instance	4
Insurance contract or identification number BF58 Number of Individuals Covered 9 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VC2057
Policy instance	3
Insurance contract or identification number VC2057 Number of Individuals Covered 14 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	GP02071
Policy instance	2
Insurance contract or identification number GP02071 Number of Individuals Covered 12 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007695-H
Policy instance	8
Insurance contract or identification number 007695-H 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 $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	311773
Policy instance	7
Insurance contract or identification number 311773 Number of Individuals Covered 2 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number	077619 001
Policy instance	6
Insurance contract or identification number 077619 001 Number of Individuals Covered 3 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	BF58
Policy instance	5
Insurance contract or identification number BF58 Number of Individuals Covered 9 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VC2057
Policy instance	4
Insurance contract or identification number VC2057 Number of Individuals Covered 17 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $476 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $476 Insurance broker organization code? 3 Insurance broker name BENEFITSCORP INC
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	077653-C
Policy instance	3
Insurance contract or identification number 077653-C Number of Individuals Covered 7 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	GP02071
Policy instance	2
Insurance contract or identification number GP02071 Number of Individuals Covered 14 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	85188-01
Policy instance	1
Insurance contract or identification number 85188-01 Number of Individuals Covered 116 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007695-H
Policy instance	8
Insurance contract or identification number 007695-H Number of Individuals Covered 1 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	311773
Policy instance	7
Insurance contract or identification number 311773 Number of Individuals Covered 4 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number	077619 001
Policy instance	6
Insurance contract or identification number 077619 001 Number of Individuals Covered 4 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	BF58
Policy instance	5
Insurance contract or identification number BF58 Number of Individuals Covered 10 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	85188-01
Policy instance	1
Insurance contract or identification number 85188-01 Number of Individuals Covered 136 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VC2057
Policy instance	4
Insurance contract or identification number VC2057 Number of Individuals Covered 21 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $528 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $528 Insurance broker organization code? 3 Insurance broker name BENEFITSCORP INC
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	077653-C
Policy instance	3
Insurance contract or identification number 077653-C Number of Individuals Covered 9 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	GP02071
Policy instance	2
Insurance contract or identification number GP02071 Number of Individuals Covered 19 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	BF58
Policy instance	5
Insurance contract or identification number BF58 Number of Individuals Covered 11 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number	077619 001
Policy instance	6
Insurance contract or identification number 077619 001 Number of Individuals Covered 5 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VC2057
Policy instance	4
Insurance contract or identification number VC2057 Number of Individuals Covered 22 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $518 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $518 Insurance broker organization code? 3 Insurance broker name BENEFITSCORP INC
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	077653-C
Policy instance	3
Insurance contract or identification number 077653-C Number of Individuals Covered 11 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	85188-01
Policy instance	1
Insurance contract or identification number 85188-01 Number of Individuals Covered 146 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007695-H
Policy instance	8
Insurance contract or identification number 007695-H Number of Individuals Covered 1 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	311773
Policy instance	7
Insurance contract or identification number 311773 Number of Individuals Covered 5 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes 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	GP02071
Policy instance	2
Insurance contract or identification number GP02071 Number of Individuals Covered 20 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	311773
Policy instance	7
Insurance contract or identification number 311773 Number of Individuals Covered 5 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	BF58
Policy instance	5
Insurance contract or identification number BF58 Number of Individuals Covered 13 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007695-H
Policy instance	8
Insurance contract or identification number 007695-H Number of Individuals Covered 1 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	077653-C
Policy instance	3
Insurance contract or identification number 077653-C Number of Individuals Covered 13 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	GP02071
Policy instance	2
Insurance contract or identification number GP02071 Number of Individuals Covered 23 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	85188-01
Policy instance	1
Insurance contract or identification number 85188-01 Number of Individuals Covered 169 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VC2057
Policy instance	4
Insurance contract or identification number VC2057 Number of Individuals Covered 26 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $496 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $496 Insurance broker organization code? 3 Insurance broker name BENEFITSCORP INC
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number	077619 001
Policy instance	6
Insurance contract or identification number 077619 001 Number of Individuals Covered 5 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	GP02071
Policy instance	2
Insurance contract or identification number GP02071 Number of Individuals Covered 23 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	077653-C
Policy instance	3
Insurance contract or identification number 077653-C Number of Individuals Covered 15 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VC2057
Policy instance	4
Insurance contract or identification number VC2057 Number of Individuals Covered 27 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $502 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $502 Insurance broker name BENEFITSCORP INC
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	BF58
Policy instance	5
Insurance contract or identification number BF58 Number of Individuals Covered 14 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number	077619 001
Policy instance	6
Insurance contract or identification number 077619 001 Number of Individuals Covered 5 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007695-H
Policy instance	8
Insurance contract or identification number 007695-H Number of Individuals Covered 1 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	311773
Policy instance	7
Insurance contract or identification number 311773 Number of Individuals Covered 6 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 unallocated funds for contracts of type guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	85188-01
Policy instance	1
Insurance contract or identification number 85188-01 Number of Individuals Covered 180 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	BF58
Policy instance	2
Insurance contract or identification number BF58 Number of Individuals Covered 17 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	85188-01
Policy instance	5
Insurance contract or identification number 85188-01 Number of Individuals Covered 191 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 unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007695-H
Policy instance	8
Insurance contract or identification number 007695-H Number of Individuals Covered 1 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VC2057
Policy instance	7
Insurance contract or identification number VC2057 Number of Individuals Covered 28 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $482 Total amount of fees paid to insurance company USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	311773
Policy instance	1
Insurance contract or identification number 311773 Number of Individuals Covered 5 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 unallocated funds for contracts of type guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number	007653-C
Policy instance	4
Insurance contract or identification number 007653-C Number of Individuals Covered 15 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $0 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	GP02071
Policy instance	3
Insurance contract or identification number GP02071 Number of Individuals Covered 29 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number	007619 001
Policy instance	6
Insurance contract or identification number 007619 001 Number of Individuals Covered 5 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number	007619 001
Policy instance	5
Insurance contract or identification number 007619 001 Number of Individuals Covered 6 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 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
TIAA-CREF (National Association of Insurance Commissioners NAIC id number: 69345 )
Policy contract number	311773
Policy instance	4
Insurance contract or identification number 311773 Number of Individuals Covered 5 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 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? Yes 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
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	BF58
Policy instance	3
Insurance contract or identification number BF58 Number of Individuals Covered 19 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	VC2057
Policy instance	2
Insurance contract or identification number VC2057 Number of Individuals Covered 28 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $448 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 Commission paid to Insurance Broker USD $448 Insurance broker organization code? 3 Insurance broker name BENEFITSCORP INC
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	85188-01
Policy instance	1
Insurance contract or identification number 85188-01 Number of Individuals Covered 204 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 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