401k Plan data: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. plan

TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 401k Plan overview

Plan Name	TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC.
Plan identification number	002

TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

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

Company Name: BROOKVILLE HOSPITAL

Employer identification number (EIN): 250984595

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about BROOKVILLE HOSPITAL

Jurisdiction of Incorporation: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE

Incorporation Date:

Company Identification Number: 713681

More information about BROOKVILLE HOSPITAL

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2019-01-01
002 2018-01-01 ROBERT MCKEE
002 2017-01-01 ROBERT MCKEE
002 2016-01-01 ROBERT MCKEE
002 2015-01-01 ROBERT MCKEE JOHN SUTIKA 2016-10-17
002 2014-01-01 ROBERT MCKEE JOHN SUTIKA 2015-10-12
002 2013-01-01 ROBERT MCKEE JOHN SUTIKA 2014-10-15
002 2012-01-01 ROBERT MCKEE ROBERT MCKEE 2013-10-15
002 2011-01-01 ROBERT MCKEE JOHN SUTIKA 2012-10-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2019-01-01
002	2018-01-01	ROBERT MCKEE
002	2017-01-01	ROBERT MCKEE
002	2016-01-01	ROBERT MCKEE
002	2015-01-01	ROBERT MCKEE	JOHN SUTIKA	2016-10-17
002	2014-01-01	ROBERT MCKEE	JOHN SUTIKA	2015-10-12
002	2013-01-01	ROBERT MCKEE	JOHN SUTIKA	2014-10-15
002	2012-01-01	ROBERT MCKEE	ROBERT MCKEE	2013-10-15
002	2011-01-01	ROBERT MCKEE	JOHN SUTIKA	2012-10-15

Plan Statistics for TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC.

401k plan membership statisitcs for TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC.

Measure Date Value
2019: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2019 401k membership
Total participants, beginning-of-year 2019-01-01 260
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 0
Number of participants with account balances 2019-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2018 401k membership
Total participants, beginning-of-year 2018-01-01 257
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 225
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 33
Total of all active and inactive participants 2018-01-01 259
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 1
Total participants 2018-01-01 260
Number of participants with account balances 2018-01-01 204
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2017 401k membership
Total participants, beginning-of-year 2017-01-01 251
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 221
Number of retired or separated participants receiving benefits 2017-01-01 1
Number of other retired or separated participants entitled to future benefits 2017-01-01 33
Total of all active and inactive participants 2017-01-01 255
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 1
Total participants 2017-01-01 256
Number of participants with account balances 2017-01-01 200
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2016 401k membership
Total participants, beginning-of-year 2016-01-01 275
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 221
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 29
Total of all active and inactive participants 2016-01-01 250
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 1
Total participants 2016-01-01 251
Number of participants with account balances 2016-01-01 198
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 275
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 241
Number of retired or separated participants receiving benefits 2015-01-01 2
Number of other retired or separated participants entitled to future benefits 2015-01-01 31
Total of all active and inactive participants 2015-01-01 274
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 1
Total participants 2015-01-01 275
Number of participants with account balances 2015-01-01 194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2014 401k membership
Total participants, beginning-of-year 2014-01-01 306
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 259
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 21
Total of all active and inactive participants 2014-01-01 280
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 280
Number of participants with account balances 2014-01-01 202
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2013 401k membership
Total participants, beginning-of-year 2013-01-01 268
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 281
Number of other retired or separated participants entitled to future benefits 2013-01-01 9
Total of all active and inactive participants 2013-01-01 290
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 291
Number of participants with account balances 2013-01-01 209
2012: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2012 401k membership
Total participants, beginning-of-year 2012-01-01 213
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 207
Total of all active and inactive participants 2012-01-01 207
Total participants 2012-01-01 207
2011: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2011 401k membership
Total participants, beginning-of-year 2011-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 198
Number of other retired or separated participants entitled to future benefits 2011-01-01 15
Total of all active and inactive participants 2011-01-01 213
Total participants 2011-01-01 213
Number of participants with account balances 2011-01-01 213

Measure	Date	Value
2019: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2019 401k membership
Total participants, beginning-of-year	2019-01-01	260
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	0
Number of participants with account balances	2019-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2018 401k membership
Total participants, beginning-of-year	2018-01-01	257
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	225
Number of retired or separated participants receiving benefits	2018-01-01	1
Number of other retired or separated participants entitled to future benefits	2018-01-01	33
Total of all active and inactive participants	2018-01-01	259
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	1
Total participants	2018-01-01	260
Number of participants with account balances	2018-01-01	204
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2017 401k membership
Total participants, beginning-of-year	2017-01-01	251
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	221
Number of retired or separated participants receiving benefits	2017-01-01	1
Number of other retired or separated participants entitled to future benefits	2017-01-01	33
Total of all active and inactive participants	2017-01-01	255
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	1
Total participants	2017-01-01	256
Number of participants with account balances	2017-01-01	200
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2016 401k membership
Total participants, beginning-of-year	2016-01-01	275
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	221
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	29
Total of all active and inactive participants	2016-01-01	250
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	1
Total participants	2016-01-01	251
Number of participants with account balances	2016-01-01	198
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	275
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	241
Number of retired or separated participants receiving benefits	2015-01-01	2
Number of other retired or separated participants entitled to future benefits	2015-01-01	31
Total of all active and inactive participants	2015-01-01	274
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	1
Total participants	2015-01-01	275
Number of participants with account balances	2015-01-01	194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	306
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	259
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	21
Total of all active and inactive participants	2014-01-01	280
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	280
Number of participants with account balances	2014-01-01	202
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2013 401k membership
Total participants, beginning-of-year	2013-01-01	268
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	281
Number of other retired or separated participants entitled to future benefits	2013-01-01	9
Total of all active and inactive participants	2013-01-01	290
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	291
Number of participants with account balances	2013-01-01	209
2012: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2012 401k membership
Total participants, beginning-of-year	2012-01-01	213
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	207
Total of all active and inactive participants	2012-01-01	207
Total participants	2012-01-01	207
2011: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2011 401k membership
Total participants, beginning-of-year	2011-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	198
Number of other retired or separated participants entitled to future benefits	2011-01-01	15
Total of all active and inactive participants	2011-01-01	213
Total participants	2011-01-01	213
Number of participants with account balances	2011-01-01	213

Financial Data on TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC.

Measure	Date	Value
2019 : TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2019 401k financial data
Total transfer of assets from this plan	2019-12-31	$9,048,646
Total income from all sources (including contributions)	2019-12-31	$2,379,231
Total of all expenses incurred	2019-12-31	$941,918
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$925,698
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$810,709
Value of total assets at end of year	2019-12-31	$0
Value of total assets at beginning of year	2019-12-31	$7,611,333
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$16,220
Total interest from all sources	2019-12-31	$11,369
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$202,787
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2019-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$202,787
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	Yes
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	$534,293
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$136,023
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$22,820
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$64
Administrative expenses (other) incurred	2019-12-31	$16,220
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	$1,437,313
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$7,611,333
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$7,381,105
Interest on participant loans	2019-12-31	$9,161
Interest earned on other investments	2019-12-31	$2,208
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$94,141
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$1,354,366
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	$253,596
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$925,698
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	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	Yes
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	BKD, LLP
Accountancy firm EIN	2019-12-31	440160260
2018 : TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$345,522
Total of all expenses incurred	2018-12-31	$430,181
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$414,814
Expenses. Certain deemed distributions of participant loans	2018-12-31	$67
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$782,425
Value of total assets at end of year	2018-12-31	$7,611,333
Value of total assets at beginning of year	2018-12-31	$7,695,992
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$15,300
Total interest from all sources	2018-12-31	$8,053
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$178,968
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	$178,968
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$505,907
Participant contributions at end of year	2018-12-31	$136,023
Participant contributions at beginning of year	2018-12-31	$123,924
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$20,939
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$64
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$54
Administrative expenses (other) incurred	2018-12-31	$15,300
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	$-84,659
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$7,611,333
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$7,695,992
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$7,381,105
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$7,491,599
Interest on participant loans	2018-12-31	$6,304
Interest earned on other investments	2018-12-31	$1,749
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$94,141
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$80,415
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-623,924
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	$255,579
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$414,814
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	No
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	BKD, LLP
Accountancy firm EIN	2018-12-31	440160260
2017 : TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$1,777,073
Total of all expenses incurred	2017-12-31	$218,596
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$194,458
Expenses. Certain deemed distributions of participant loans	2017-12-31	$9,716
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$728,821
Value of total assets at end of year	2017-12-31	$7,695,992
Value of total assets at beginning of year	2017-12-31	$6,137,515
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$14,422
Total interest from all sources	2017-12-31	$6,459
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$142,811
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$142,811
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$461,229
Participant contributions at end of year	2017-12-31	$123,924
Participant contributions at beginning of year	2017-12-31	$106,125
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$7,733
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$54
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$144
Administrative expenses (other) incurred	2017-12-31	$14,422
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	$1,558,477
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$7,695,992
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$6,137,515
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$7,491,599
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$5,937,564
Interest on participant loans	2017-12-31	$4,941
Interest earned on other investments	2017-12-31	$1,518
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$80,415
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$93,682
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$898,982
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	$259,859
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$194,458
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	No
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	BKD, LLP
Accountancy firm EIN	2017-12-31	440160260
2016 : TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2016 401k financial data
Total income from all sources (including contributions)	2016-12-31	$1,369,514
Total of all expenses incurred	2016-12-31	$501,623
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$478,810
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$974,526
Value of total assets at end of year	2016-12-31	$6,137,515
Value of total assets at beginning of year	2016-12-31	$5,269,624
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$22,813
Total interest from all sources	2016-12-31	$8,542
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$130,556
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$130,556
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	Yes
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	$431,835
Participant contributions at end of year	2016-12-31	$106,125
Participant contributions at beginning of year	2016-12-31	$98,257
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$14,661
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$302,776
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$144
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$0
Administrative expenses (other) incurred	2016-12-31	$22,813
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	$867,891
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$6,137,515
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$5,269,624
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$5,937,564
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$4,423,482
Interest on participant loans	2016-12-31	$4,414
Interest earned on other investments	2016-12-31	$4,128
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$93,682
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$724,674
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$255,890
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	$239,915
Employer contributions (assets) at end of year	2016-12-31	$0
Employer contributions (assets) at beginning of year	2016-12-31	$8,550
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$478,810
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-12-31	Yes
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	BKD, LLP
Accountancy firm EIN	2016-12-31	440160260
2015 : TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets to this plan	2015-12-31	$0
Total transfer of assets from this plan	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Expenses. Interest paid	2015-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$709,700
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$435,776
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$365,431
Value of total corrective distributions	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$697,524
Value of total assets at end of year	2015-12-31	$5,269,624
Value of total assets at beginning of year	2015-12-31	$4,995,700
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$70,345
Total interest from all sources	2015-12-31	$15,180
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$174,736
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$174,736
Administrative expenses professional fees incurred	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$426,578
Participant contributions at end of year	2015-12-31	$98,257
Participant contributions at beginning of year	2015-12-31	$76,839
Participant contributions at end of year	2015-12-31	$14,661
Administrative expenses (other) incurred	2015-12-31	$70,345
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	$273,924
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$5,269,624
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$4,995,700
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	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$4,423,482
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$4,307,193
Interest on participant loans	2015-12-31	$3,382
Interest earned on other investments	2015-12-31	$11,798
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$724,674
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$611,668
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-177,740
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	$270,946
Employer contributions (assets) at end of year	2015-12-31	$8,550
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$365,431
Contract administrator fees	2015-12-31	$0
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	BKD
Accountancy firm EIN	2015-12-31	440160260
2014 : TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$1,012,002
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$353,505
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$302,014
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$750,059
Value of total assets at end of year	2014-12-31	$4,995,700
Value of total assets at beginning of year	2014-12-31	$4,337,203
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$51,491
Total interest from all sources	2014-12-31	$15,814
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$192,277
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$192,277
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$417,654
Participant contributions at end of year	2014-12-31	$76,839
Participant contributions at beginning of year	2014-12-31	$50,197
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$46,470
Administrative expenses (other) incurred	2014-12-31	$51,491
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	$658,497
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$4,995,700
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$4,337,203
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$4,307,193
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$2,900,603
Interest on participant loans	2014-12-31	$2,457
Interest earned on other investments	2014-12-31	$13,357
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$611,668
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$1,386,403
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$53,852
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	$285,935
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$302,014
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-12-31	No
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	BKD
Accountancy firm EIN	2014-12-31	440160260
2013 : TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$1,181,542
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$225,588
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$177,972
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$738,092
Value of total assets at end of year	2013-12-31	$4,337,203
Value of total assets at beginning of year	2013-12-31	$3,381,249
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$47,616
Total interest from all sources	2013-12-31	$23,337
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$92,063
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$92,063
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$437,923
Participant contributions at end of year	2013-12-31	$50,197
Participant contributions at beginning of year	2013-12-31	$15,248
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$24,312
Administrative expenses (other) incurred	2013-12-31	$47,616
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	$955,954
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$4,337,203
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$3,381,249
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$2,900,603
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$2,136,972
Interest on participant loans	2013-12-31	$1,171
Interest earned on other investments	2013-12-31	$22,166
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$1,386,403
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$1,229,029
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$328,050
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	$275,857
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$177,972
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
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	BKD
Accountancy firm EIN	2013-12-31	440160260
2012 : TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2012 401k financial data
Total transfer of assets to this plan	2012-12-31	$1,880,330
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$726
Total income from all sources (including contributions)	2012-12-31	$848,976
Total of all expenses incurred	2012-12-31	$54,000
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$25,610
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$676,422
Value of total assets at end of year	2012-12-31	$3,381,249
Value of total assets at beginning of year	2012-12-31	$706,669
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$28,390
Total interest from all sources	2012-12-31	$256
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$72,091
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$72,091
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$401,140
Participant contributions at end of year	2012-12-31	$15,248
Participant contributions at beginning of year	2012-12-31	$2,190
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$726
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$726
Other income not declared elsewhere	2012-12-31	$10,179
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$794,976
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$3,381,249
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$705,943
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$2,136,972
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$467,216
Interest on participant loans	2012-12-31	$256
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$2,043
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$2,043
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$1,229,029
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$234,494
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$90,028
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	$275,282
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$25,610
Contract administrator fees	2012-12-31	$28,390
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	BKD, LLP
Accountancy firm EIN	2012-12-31	440160260
2011 : TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$726
Total income from all sources (including contributions)	2011-12-31	$712,063
Total of all expenses incurred	2011-12-31	$6,120
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$2,684
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$718,184
Value of total assets at end of year	2011-12-31	$706,669
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$3,436
Total interest from all sources	2011-12-31	$15
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$10,819
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$10,819
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$291,214
Participant contributions at end of year	2011-12-31	$2,190
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$151,487
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$726
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$726
Other income not declared elsewhere	2011-12-31	$2,584
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	$705,943
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$705,943
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	$1,020
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$467,216
Interest on participant loans	2011-12-31	$15
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$2,043
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$234,494
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-19,539
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	$275,483
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$2,684
Contract administrator fees	2011-12-31	$2,416
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	BKD, LLP
Accountancy firm EIN	2011-12-31	440160260

Form 5500 Responses for TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC.

2019: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	This submission is the final filing	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 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: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 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: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: TAX DEFERRED ANNUITY PLAN OF BROOKVILLE HOSPITAL, INC. 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

TA069818

Policy instance

Insurance contract or identification number	TA069818
Number of Individuals Covered	0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

TA069818

Policy instance

Insurance contract or identification number	TA069818
Number of Individuals Covered	204
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

TA069818

Policy instance

Insurance contract or identification number	TA069818
Number of Individuals Covered	200
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
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

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

Policy contract number

893293007

Policy instance

Insurance contract or identification number	893293007
Number of Individuals Covered	291
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

893293007

Policy instance

Insurance contract or identification number	893293007
Number of Individuals Covered	207
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

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

Policy contract number

893293007

Policy instance

Insurance contract or identification number	893293007
Number of Individuals Covered	196
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $483
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

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Company Name:	BROOKVILLE HOSPITAL
Employer identification number (EIN):	250984595
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE
Incorporation Date:
Company Identification Number:	713681