401k Plan data: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER plan

TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 401k Plan overview

Plan Name	TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER
Plan identification number	002

TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

DUBOIS REGIONAL MEDICAL CENTER INC has sponsored the creation of one or more 401k plans.

Company Name: DUBOIS REGIONAL MEDICAL CENTER INC

Employer identification number (EIN): 251490707

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER

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
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 2015-10-13
002 2013-01-01 ROBERT MCKEE JOHN SUTIKA 2014-10-15
002 2012-01-01 ROBERT MCKEE JOHN SUTIKA 2013-08-07
002 2011-01-01 ROBERT MCKEE JOHN SUTIKA 2012-08-01
002 2009-01-01 ROBERT MCKEE RAYMOND GRAECA 2010-10-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2019-01-01
002	2018-01-01
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	2015-10-13
002	2013-01-01	ROBERT MCKEE	JOHN SUTIKA	2014-10-15
002	2012-01-01	ROBERT MCKEE	JOHN SUTIKA	2013-08-07
002	2011-01-01	ROBERT MCKEE	JOHN SUTIKA	2012-08-01
002	2009-01-01	ROBERT MCKEE	RAYMOND GRAECA	2010-10-15

Plan Statistics for TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER

401k plan membership statisitcs for TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER

Measure Date Value
2019: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2019 401k membership
Total participants, beginning-of-year 2019-01-01 2,684
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 2,384
Number of retired or separated participants receiving benefits 2019-01-01 2
Number of other retired or separated participants entitled to future benefits 2019-01-01 396
Total of all active and inactive participants 2019-01-01 2,782
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 2
Total participants 2019-01-01 2,784
Number of participants with account balances 2019-01-01 2,587
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 DUBOIS REGIONAL MEDICAL CENTER 2018 401k membership
Total participants, beginning-of-year 2018-01-01 2,473
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 2,323
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 341
Total of all active and inactive participants 2018-01-01 2,665
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 3
Total participants 2018-01-01 2,668
Number of participants with account balances 2018-01-01 2,513
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 DUBOIS REGIONAL MEDICAL CENTER 2017 401k membership
Total participants, beginning-of-year 2017-01-01 2,135
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 2,165
Number of retired or separated participants receiving benefits 2017-01-01 2
Number of other retired or separated participants entitled to future benefits 2017-01-01 281
Total of all active and inactive participants 2017-01-01 2,448
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 1
Total participants 2017-01-01 2,449
Number of participants with account balances 2017-01-01 1,694
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 DUBOIS REGIONAL MEDICAL CENTER 2016 401k membership
Total participants, beginning-of-year 2016-01-01 2,058
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 2,064
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 68
Total of all active and inactive participants 2016-01-01 2,132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 1
Total participants 2016-01-01 2,133
Number of participants with account balances 2016-01-01 1,664
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 DUBOIS REGIONAL MEDICAL CENTER 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,774
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,554
Number of retired or separated participants receiving benefits 2015-01-01 35
Number of other retired or separated participants entitled to future benefits 2015-01-01 461
Total of all active and inactive participants 2015-01-01 2,050
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 7
Total participants 2015-01-01 2,057
Number of participants with account balances 2015-01-01 1,772
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 51
2014: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,627
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,434
Number of retired or separated participants receiving benefits 2014-01-01 34
Number of other retired or separated participants entitled to future benefits 2014-01-01 302
Total of all active and inactive participants 2014-01-01 1,770
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 2
Total participants 2014-01-01 1,772
Number of participants with account balances 2014-01-01 1,770
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 DUBOIS REGIONAL MEDICAL CENTER 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,575
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,315
Number of other retired or separated participants entitled to future benefits 2013-01-01 347
Total of all active and inactive participants 2013-01-01 1,662
Total participants 2013-01-01 1,662
Number of participants with account balances 2013-01-01 1,662
2012: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,535
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,210
Number of other retired or separated participants entitled to future benefits 2012-01-01 365
Total of all active and inactive participants 2012-01-01 1,575
Total participants 2012-01-01 1,575
Number of participants with account balances 2012-01-01 1,575
2011: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,540
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,290
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 245
Total of all active and inactive participants 2011-01-01 1,535
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 1,535
Number of participants with account balances 2011-01-01 1,535
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,434
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,230
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 225
Total of all active and inactive participants 2009-01-01 1,455
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 7
Total participants 2009-01-01 1,462
Number of participants with account balances 2009-01-01 1,462
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2019: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2019 401k membership
Total participants, beginning-of-year	2019-01-01	2,684
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	2,384
Number of retired or separated participants receiving benefits	2019-01-01	2
Number of other retired or separated participants entitled to future benefits	2019-01-01	396
Total of all active and inactive participants	2019-01-01	2,782
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	2
Total participants	2019-01-01	2,784
Number of participants with account balances	2019-01-01	2,587
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 DUBOIS REGIONAL MEDICAL CENTER 2018 401k membership
Total participants, beginning-of-year	2018-01-01	2,473
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	2,323
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	341
Total of all active and inactive participants	2018-01-01	2,665
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	3
Total participants	2018-01-01	2,668
Number of participants with account balances	2018-01-01	2,513
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 DUBOIS REGIONAL MEDICAL CENTER 2017 401k membership
Total participants, beginning-of-year	2017-01-01	2,135
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	2,165
Number of retired or separated participants receiving benefits	2017-01-01	2
Number of other retired or separated participants entitled to future benefits	2017-01-01	281
Total of all active and inactive participants	2017-01-01	2,448
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	1
Total participants	2017-01-01	2,449
Number of participants with account balances	2017-01-01	1,694
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 DUBOIS REGIONAL MEDICAL CENTER 2016 401k membership
Total participants, beginning-of-year	2016-01-01	2,058
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	2,064
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	68
Total of all active and inactive participants	2016-01-01	2,132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	1
Total participants	2016-01-01	2,133
Number of participants with account balances	2016-01-01	1,664
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 DUBOIS REGIONAL MEDICAL CENTER 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,774
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,554
Number of retired or separated participants receiving benefits	2015-01-01	35
Number of other retired or separated participants entitled to future benefits	2015-01-01	461
Total of all active and inactive participants	2015-01-01	2,050
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	7
Total participants	2015-01-01	2,057
Number of participants with account balances	2015-01-01	1,772
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	51
2014: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,627
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,434
Number of retired or separated participants receiving benefits	2014-01-01	34
Number of other retired or separated participants entitled to future benefits	2014-01-01	302
Total of all active and inactive participants	2014-01-01	1,770
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	2
Total participants	2014-01-01	1,772
Number of participants with account balances	2014-01-01	1,770
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 DUBOIS REGIONAL MEDICAL CENTER 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,575
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,315
Number of other retired or separated participants entitled to future benefits	2013-01-01	347
Total of all active and inactive participants	2013-01-01	1,662
Total participants	2013-01-01	1,662
Number of participants with account balances	2013-01-01	1,662
2012: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,535
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,210
Number of other retired or separated participants entitled to future benefits	2012-01-01	365
Total of all active and inactive participants	2012-01-01	1,575
Total participants	2012-01-01	1,575
Number of participants with account balances	2012-01-01	1,575
2011: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,540
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,290
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	245
Total of all active and inactive participants	2011-01-01	1,535
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	1,535
Number of participants with account balances	2011-01-01	1,535
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,434
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,230
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	225
Total of all active and inactive participants	2009-01-01	1,455
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	7
Total participants	2009-01-01	1,462
Number of participants with account balances	2009-01-01	1,462
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER

Measure	Date	Value
2019 : TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2019 401k financial data
Total transfer of assets to this plan	2019-12-31	$40,883,609
Total income from all sources (including contributions)	2019-12-31	$39,685,094
Total of all expenses incurred	2019-12-31	$8,763,196
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$8,588,816
Expenses. Certain deemed distributions of participant loans	2019-12-31	$13,735
Value of total corrective distributions	2019-12-31	$2,160
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$13,497,426
Value of total assets at end of year	2019-12-31	$202,608,791
Value of total assets at beginning of year	2019-12-31	$130,803,284
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$158,485
Total interest from all sources	2019-12-31	$578,627
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$2,297,123
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	$2,297,123
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	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	$8,136,225
Participant contributions at end of year	2019-12-31	$1,329,072
Participant contributions at beginning of year	2019-12-31	$1,234,938
Participant contributions at beginning of year	2019-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$1,463,270
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$40,885,164
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$520
Administrative expenses (other) incurred	2019-12-31	$158,485
Total non interest bearing cash at end of year	2019-12-31	$0
Total non interest bearing cash at beginning of year	2019-12-31	$34,036
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	$30,921,898
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$202,608,791
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$130,803,284
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	$104,818,051
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$75,966,776
Value of interest in pooled separate accounts at end of year	2019-12-31	$36,963,727
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$34,472,034
Interest on participant loans	2019-12-31	$71,924
Interest earned on other investments	2019-12-31	$506,703
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$18,612,777
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$19,094,980
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$15,866,342
Net investment gain/loss from pooled separate accounts	2019-12-31	$7,445,576
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	$3,897,931
Employer contributions (assets) at beginning of year	2019-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$8,588,816
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	No
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	BKD, LLP
Accountancy firm EIN	2019-12-31	440160260
2018 : TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$5,129,275
Total of all expenses incurred	2018-12-31	$13,445,401
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$13,288,662
Expenses. Certain deemed distributions of participant loans	2018-12-31	$8,290
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$12,075,679
Value of total assets at end of year	2018-12-31	$130,803,284
Value of total assets at beginning of year	2018-12-31	$139,119,410
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$148,449
Total interest from all sources	2018-12-31	$546,221
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$1,823,084
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	$1,823,084
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	$7,309,060
Participant contributions at end of year	2018-12-31	$1,234,938
Participant contributions at beginning of year	2018-12-31	$930,395
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$243,855
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$1,188,311
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$520
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$1,180
Administrative expenses (other) incurred	2018-12-31	$148,449
Total non interest bearing cash at end of year	2018-12-31	$34,036
Total non interest bearing cash at beginning of year	2018-12-31	$56,272
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	$-8,316,126
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$130,803,284
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$139,119,410
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	$75,966,776
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$73,042,648
Value of interest in pooled separate accounts at end of year	2018-12-31	$34,472,034
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$42,716,934
Interest on participant loans	2018-12-31	$56,192
Interest earned on other investments	2018-12-31	$490,029
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$19,094,980
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$22,022,160
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-6,647,349
Net investment gain/loss from pooled separate accounts	2018-12-31	$-2,668,360
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	$3,578,308
Employer contributions (assets) at end of year	2018-12-31	$0
Employer contributions (assets) at beginning of year	2018-12-31	$105,966
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$13,288,662
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 DUBOIS REGIONAL MEDICAL CENTER 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$28,196,706
Total of all expenses incurred	2017-12-31	$11,647,556
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$11,373,937
Expenses. Certain deemed distributions of participant loans	2017-12-31	$137,164
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$10,603,048
Value of total assets at end of year	2017-12-31	$139,119,410
Value of total assets at beginning of year	2017-12-31	$122,570,260
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$136,455
Total interest from all sources	2017-12-31	$609,968
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$1,335,359
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$1,335,359
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	$6,649,247
Participant contributions at end of year	2017-12-31	$930,395
Participant contributions at beginning of year	2017-12-31	$927,970
Participant contributions at end of year	2017-12-31	$243,855
Participant contributions at beginning of year	2017-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$605,965
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$1,180
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$121
Administrative expenses (other) incurred	2017-12-31	$136,455
Total non interest bearing cash at end of year	2017-12-31	$56,272
Total non interest bearing cash at beginning of year	2017-12-31	$278,294
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	$16,549,150
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$139,119,410
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$122,570,260
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	$73,042,648
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$51,357,344
Value of interest in pooled separate accounts at end of year	2017-12-31	$42,716,934
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$45,389,897
Interest on participant loans	2017-12-31	$43,888
Interest earned on other investments	2017-12-31	$566,080
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$22,022,160
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$24,616,634
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$8,869,429
Net investment gain/loss from pooled separate accounts	2017-12-31	$6,778,902
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	$3,347,836
Employer contributions (assets) at end of year	2017-12-31	$105,966
Employer contributions (assets) at beginning of year	2017-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$11,373,937
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 DUBOIS REGIONAL MEDICAL CENTER 2016 401k financial data
Total income from all sources (including contributions)	2016-12-31	$19,436,090
Total of all expenses incurred	2016-12-31	$17,186,170
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$17,107,195
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$11,423,456
Value of total assets at end of year	2016-12-31	$122,570,260
Value of total assets at beginning of year	2016-12-31	$120,320,340
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$78,975
Total interest from all sources	2016-12-31	$688,212
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$925,002
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	$925,002
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	$6,227,338
Participant contributions at end of year	2016-12-31	$927,970
Participant contributions at beginning of year	2016-12-31	$795,967
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$236,165
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$2,042,010
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$121
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$0
Administrative expenses (other) incurred	2016-12-31	$78,975
Total non interest bearing cash at end of year	2016-12-31	$278,294
Total non interest bearing cash at beginning of year	2016-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$2,249,920
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$122,570,260
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$120,320,340
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	$51,357,344
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$54,775,548
Value of interest in pooled separate accounts at end of year	2016-12-31	$45,389,897
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$35,969,154
Interest on participant loans	2016-12-31	$42,594
Interest earned on other investments	2016-12-31	$645,618
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$24,616,634
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$28,443,240
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$1,325,496
Net investment gain/loss from pooled separate accounts	2016-12-31	$5,073,924
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	$3,154,108
Employer contributions (assets) at end of year	2016-12-31	$0
Employer contributions (assets) at beginning of year	2016-12-31	$100,266
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$17,107,195
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 DUBOIS REGIONAL MEDICAL CENTER 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$9,854,400
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$12,321,730
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$12,259,370
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$9,663,058
Value of total assets at end of year	2015-12-31	$120,320,340
Value of total assets at beginning of year	2015-12-31	$122,787,670
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$62,360
Total interest from all sources	2015-12-31	$780,127
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$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	$6,078,301
Participant contributions at end of year	2015-12-31	$795,967
Participant contributions at beginning of year	2015-12-31	$837,363
Participant contributions at end of year	2015-12-31	$236,165
Participant contributions at beginning of year	2015-12-31	$103,905
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$511,589
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	$-2,467,330
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$120,320,340
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$122,787,670
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$54,775,548
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$54,857,990
Value of interest in pooled separate accounts at end of year	2015-12-31	$35,969,154
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$36,516,085
Interest on participant loans	2015-12-31	$50,266
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$729,861
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$28,443,240
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$30,233,547
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-393,811
Net investment gain/loss from pooled separate accounts	2015-12-31	$-194,974
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	$3,073,168
Employer contributions (assets) at end of year	2015-12-31	$100,266
Employer contributions (assets) at beginning of year	2015-12-31	$238,780
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$12,259,370
Contract administrator fees	2015-12-31	$62,360
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 LLP
Accountancy firm EIN	2015-12-31	440160260
2014 : TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 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	$16,050,962
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$7,428,977
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$7,371,338
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$9,439,586
Value of total assets at end of year	2014-12-31	$122,787,670
Value of total assets at beginning of year	2014-12-31	$114,165,685
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$57,639
Total interest from all sources	2014-12-31	$767,729
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$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	$5,991,613
Participant contributions at end of year	2014-12-31	$837,363
Participant contributions at beginning of year	2014-12-31	$770,715
Participant contributions at end of year	2014-12-31	$103,905
Participant contributions at beginning of year	2014-12-31	$217,704
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$443,669
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	$8,621,985
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$122,787,670
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$114,165,685
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	$54,857,990
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$51,495,070
Value of interest in pooled separate accounts at end of year	2014-12-31	$36,516,085
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$33,297,227
Interest on participant loans	2014-12-31	$33,070
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$734,659
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$30,233,547
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$28,295,737
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$3,278,207
Net investment gain/loss from pooled separate accounts	2014-12-31	$2,565,440
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	$3,004,304
Employer contributions (assets) at end of year	2014-12-31	$238,780
Employer contributions (assets) at beginning of year	2014-12-31	$89,232
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$7,371,338
Contract administrator fees	2014-12-31	$57,639
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 LLP
Accountancy firm EIN	2014-12-31	440160260
2013 : TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 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	$26,189,896
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$5,281,626
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$5,235,876
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$9,428,124
Value of total assets at end of year	2013-12-31	$114,165,685
Value of total assets at beginning of year	2013-12-31	$93,257,415
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$45,750
Total interest from all sources	2013-12-31	$760,492
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$5,611,414
Participant contributions at end of year	2013-12-31	$770,715
Participant contributions at beginning of year	2013-12-31	$647,480
Participant contributions at end of year	2013-12-31	$217,704
Participant contributions at beginning of year	2013-12-31	$220,005
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$1,043,232
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	$20,908,270
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$114,165,685
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$93,257,415
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	$51,495,070
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$40,399,483
Value of interest in pooled separate accounts at end of year	2013-12-31	$33,297,227
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$26,775,958
Interest on participant loans	2013-12-31	$26,204
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$734,288
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$28,295,737
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$25,130,571
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$9,431,652
Net investment gain/loss from pooled separate accounts	2013-12-31	$6,569,628
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	$2,773,478
Employer contributions (assets) at end of year	2013-12-31	$89,232
Employer contributions (assets) at beginning of year	2013-12-31	$83,918
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$5,235,876
Contract administrator fees	2013-12-31	$45,750
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 LLP
Accountancy firm EIN	2013-12-31	440160260
2012 : TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$16,801,981
Total of all expenses incurred	2012-12-31	$5,270,491
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$5,241,560
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$8,211,337
Value of total assets at end of year	2012-12-31	$93,257,416
Value of total assets at beginning of year	2012-12-31	$81,725,925
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$28,931
Total interest from all sources	2012-12-31	$705,283
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	$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	$5,173,049
Participant contributions at end of year	2012-12-31	$647,480
Participant contributions at beginning of year	2012-12-31	$570,096
Participant contributions at end of year	2012-12-31	$220,005
Participant contributions at beginning of year	2012-12-31	$215,066
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$432,576
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	$11,531,490
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$93,257,416
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$81,725,925
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	$40,399,483
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$35,775,687
Value of interest in pooled separate accounts at end of year	2012-12-31	$26,775,958
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$22,615,967
Interest on participant loans	2012-12-31	$23,930
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$681,353
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$25,130,572
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$22,467,498
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$4,806,499
Net investment gain/loss from pooled separate accounts	2012-12-31	$3,078,862
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	$2,605,712
Employer contributions (assets) at end of year	2012-12-31	$83,918
Employer contributions (assets) at beginning of year	2012-12-31	$81,611
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$5,241,560
Contract administrator fees	2012-12-31	$28,931
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 DUBOIS REGIONAL MEDICAL CENTER 2011 401k financial data
Total income from all sources (including contributions)	2011-12-31	$7,297,356
Total of all expenses incurred	2011-12-31	$4,101,619
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$4,081,478
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$7,430,082
Value of total assets at end of year	2011-12-31	$81,725,925
Value of total assets at beginning of year	2011-12-31	$78,530,188
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$20,141
Total interest from all sources	2011-12-31	$679,386
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	$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	$4,861,569
Participant contributions at end of year	2011-12-31	$570,096
Participant contributions at beginning of year	2011-12-31	$560,713
Participant contributions at end of year	2011-12-31	$215,066
Participant contributions at beginning of year	2011-12-31	$182,936
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$94,074
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	$3,195,737
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$81,725,925
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$78,530,188
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$35,775,687
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$35,702,137
Value of interest in pooled separate accounts at end of year	2011-12-31	$22,615,967
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$21,839,311
Interest on participant loans	2011-12-31	$27,434
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$651,952
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$22,467,498
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$20,165,944
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-445,426
Net investment gain/loss from pooled separate accounts	2011-12-31	$-366,686
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	$2,474,439
Employer contributions (assets) at end of year	2011-12-31	$81,611
Employer contributions (assets) at beginning of year	2011-12-31	$79,147
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$4,081,478
Contract administrator fees	2011-12-31	$20,141
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
2010 : TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$15,248,297
Total of all expenses incurred	2010-12-31	$3,395,900
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$3,380,573
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$7,535,047
Value of total assets at end of year	2010-12-31	$78,530,188
Value of total assets at beginning of year	2010-12-31	$66,677,791
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$15,327
Total interest from all sources	2010-12-31	$664,749
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$4,696,312
Participant contributions at end of year	2010-12-31	$560,713
Participant contributions at beginning of year	2010-12-31	$568,263
Participant contributions at end of year	2010-12-31	$182,936
Participant contributions at beginning of year	2010-12-31	$119,032
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$451,068
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	$11,852,397
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$78,530,188
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$66,677,791
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$35,702,137
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$29,918,140
Value of interest in pooled separate accounts at end of year	2010-12-31	$21,839,311
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$17,225,633
Interest on participant loans	2010-12-31	$29,304
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$635,445
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$20,165,944
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$18,782,383
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$4,092,951
Net investment gain/loss from pooled separate accounts	2010-12-31	$2,955,550
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	$2,387,667
Employer contributions (assets) at end of year	2010-12-31	$79,147
Employer contributions (assets) at beginning of year	2010-12-31	$64,340
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$3,380,573
Contract administrator fees	2010-12-31	$15,327
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	BKD, LLP
Accountancy firm EIN	2010-12-31	440160260

Form 5500 Responses for TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER

2019: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan 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 DUBOIS REGIONAL MEDICAL CENTER 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 DUBOIS REGIONAL MEDICAL CENTER 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 DUBOIS REGIONAL MEDICAL CENTER 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 DUBOIS REGIONAL MEDICAL CENTER 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 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 DUBOIS REGIONAL MEDICAL CENTER 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 DUBOIS REGIONAL MEDICAL CENTER 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: TAX DEFERRED ANNUITY PLAN OF DUBOIS REGIONAL MEDICAL CENTER 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan 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

TA069821

Policy instance

Insurance contract or identification number	TA069821
Number of Individuals Covered	1853
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

85616-01

Policy instance

Insurance contract or identification number	85616-01
Number of Individuals Covered	296
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

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

007657-K

Policy instance

Insurance contract or identification number	007657-K
Number of Individuals Covered	261
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

85616-01

Policy instance

Insurance contract or identification number	85616-01
Number of Individuals Covered	569
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
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

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

Policy contract number

TA069821

Policy instance

Insurance contract or identification number	TA069821
Number of Individuals Covered	1536
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

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

007657-K

Policy instance

Insurance contract or identification number	007657-K
Number of Individuals Covered	351
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $8,979
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
Amount paid for insurance broker fees	8979
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP PROGRAM
Insurance broker organization code?	3
Insurance broker name	PITTSBURGH REGIONAL OFFICE

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

85616-01

Policy instance

Insurance contract or identification number	85616-01
Number of Individuals Covered	885
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

007657-K

Policy instance

Insurance contract or identification number	007657-K
Number of Individuals Covered	887
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of fees paid to insurance company	USD $3,213
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Amount paid for insurance broker fees	3213
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP PROGRAM
Insurance broker organization code?	3
Insurance broker name	PITTSBURGH REGIONAL OFFICE

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

007657-K

Policy instance

Insurance contract or identification number	007657-K
Number of Individuals Covered	892
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of fees paid to insurance company	USD $2,638
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Amount paid for insurance broker fees	2638
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP PROGRAM
Insurance broker organization code?	3
Insurance broker name	PITTSBURGH REGIONAL OFFICE

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

85616-01

Policy instance

Insurance contract or identification number	85616-01
Number of Individuals Covered	880
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 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

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

007657-K

Policy instance

Insurance contract or identification number	007657-K
Number of Individuals Covered	771
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of fees paid to insurance company	USD $14,043
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Amount paid for insurance broker fees	14043
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP PROGRAM
Insurance broker organization code?	3
Insurance broker name	PITTSBURGH REGIONAL OFFICE

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

85616-01

Policy instance

Insurance contract or identification number	85616-01
Number of Individuals Covered	856
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

85616-01

Policy instance

Insurance contract or identification number	85616-01
Number of Individuals Covered	843
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

004657-K

Policy instance

Insurance contract or identification number	004657-K
Number of Individuals Covered	732
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,759
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
Amount paid for insurance broker fees	1168
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMPENSATION PROGRAM
Insurance broker organization code?	3
Insurance broker name	DAVID HOLETS

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

007657-K

Policy instance

Insurance contract or identification number	007657-K
Number of Individuals Covered	704
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,902
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

85616-01

Policy instance

Insurance contract or identification number	85616-01
Number of Individuals Covered	831
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

85616-01

Policy instance

Insurance contract or identification number	85616-01
Number of Individuals Covered	833
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with 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

007657-K

Policy instance

Insurance contract or identification number	007657-K
Number of Individuals Covered	688
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,655
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	1556
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	JOHN HILZENDEGER

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Company Name:	DUBOIS REGIONAL MEDICAL CENTER INC
Employer identification number (EIN):	251490707
NAIC Classification:	622000
NAIC Description:	Hospitals