401k Plan data: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER plan

CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 401k Plan overview

Plan Name	CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER
Plan identification number	003

CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Target benefit plan
Offset plan - Plan benefits are subject to offset for retirement benefits provided in another plan or arrangement of the employer.
Profit-sharing
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.
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

COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC. has sponsored the creation of one or more 401k plans.

Company Name: COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC.

Employer identification number (EIN): 311128781

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2015-01-01 ANTHONY FERRACANE
003 2014-01-01 ANTHONY FERRACANE
003 2013-01-01 ANTHONY FERRACANE
003 2012-01-01 ANTHONY FERRACANE ANTHONY FERRACANE 2013-10-07
003 2011-01-01 ANTHONY FERRACANE ANTHONY FERRACANE 2012-10-11
003 2009-01-01 ANTHONY FERRACANE
003 2008-01-01

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
003	2015-01-01	ANTHONY FERRACANE
003	2014-01-01	ANTHONY FERRACANE
003	2013-01-01	ANTHONY FERRACANE
003	2012-01-01	ANTHONY FERRACANE	ANTHONY FERRACANE	2013-10-07
003	2011-01-01	ANTHONY FERRACANE	ANTHONY FERRACANE	2012-10-11
003	2009-01-01	ANTHONY FERRACANE
003	2008-01-01

Plan Statistics for CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER

401k plan membership statisitcs for CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER

Measure Date Value
2015: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2015 401k membership
Total participants, beginning-of-year 2015-01-01 2,610
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2014 401k membership
Total participants, beginning-of-year 2014-01-01 3,286
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 2,437
Number of retired or separated participants receiving benefits 2014-01-01 7
Number of other retired or separated participants entitled to future benefits 2014-01-01 165
Total of all active and inactive participants 2014-01-01 2,609
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 1
Total participants 2014-01-01 2,610
Number of participants with account balances 2014-01-01 830
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2013 401k membership
Total participants, beginning-of-year 2013-01-01 4,986
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 3,166
Number of retired or separated participants receiving benefits 2013-01-01 6
Number of other retired or separated participants entitled to future benefits 2013-01-01 112
Total of all active and inactive participants 2013-01-01 3,284
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 2
Total participants 2013-01-01 3,286
Number of participants with account balances 2013-01-01 930
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2012 401k membership
Total participants, beginning-of-year 2012-01-01 4,714
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 4,851
Number of retired or separated participants receiving benefits 2012-01-01 6
Number of other retired or separated participants entitled to future benefits 2012-01-01 129
Total of all active and inactive participants 2012-01-01 4,986
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 4,986
Number of participants with account balances 2012-01-01 995
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2011 401k membership
Total participants, beginning-of-year 2011-01-01 3,817
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4,564
Number of retired or separated participants receiving benefits 2011-01-01 7
Number of other retired or separated participants entitled to future benefits 2011-01-01 139
Total of all active and inactive participants 2011-01-01 4,710
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 4
Total participants 2011-01-01 4,714
Number of participants with account balances 2011-01-01 1,066
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2009 401k membership
Total participants, beginning-of-year 2009-01-01 2,380
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 3,277
Number of retired or separated participants receiving benefits 2009-01-01 6
Number of other retired or separated participants entitled to future benefits 2009-01-01 146
Total of all active and inactive participants 2009-01-01 3,429
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 3,430
Number of participants with account balances 2009-01-01 1,166
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2015: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2015 401k membership
Total participants, beginning-of-year	2015-01-01	2,610
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2014 401k membership
Total participants, beginning-of-year	2014-01-01	3,286
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2,437
Number of retired or separated participants receiving benefits	2014-01-01	7
Number of other retired or separated participants entitled to future benefits	2014-01-01	165
Total of all active and inactive participants	2014-01-01	2,609
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	1
Total participants	2014-01-01	2,610
Number of participants with account balances	2014-01-01	830
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2013 401k membership
Total participants, beginning-of-year	2013-01-01	4,986
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	3,166
Number of retired or separated participants receiving benefits	2013-01-01	6
Number of other retired or separated participants entitled to future benefits	2013-01-01	112
Total of all active and inactive participants	2013-01-01	3,284
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	2
Total participants	2013-01-01	3,286
Number of participants with account balances	2013-01-01	930
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2012 401k membership
Total participants, beginning-of-year	2012-01-01	4,714
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	4,851
Number of retired or separated participants receiving benefits	2012-01-01	6
Number of other retired or separated participants entitled to future benefits	2012-01-01	129
Total of all active and inactive participants	2012-01-01	4,986
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	4,986
Number of participants with account balances	2012-01-01	995
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2011 401k membership
Total participants, beginning-of-year	2011-01-01	3,817
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4,564
Number of retired or separated participants receiving benefits	2011-01-01	7
Number of other retired or separated participants entitled to future benefits	2011-01-01	139
Total of all active and inactive participants	2011-01-01	4,710
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	4
Total participants	2011-01-01	4,714
Number of participants with account balances	2011-01-01	1,066
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2009 401k membership
Total participants, beginning-of-year	2009-01-01	2,380
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	3,277
Number of retired or separated participants receiving benefits	2009-01-01	6
Number of other retired or separated participants entitled to future benefits	2009-01-01	146
Total of all active and inactive participants	2009-01-01	3,429
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	3,430
Number of participants with account balances	2009-01-01	1,166
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER

Measure	Date	Value
2015 : CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets from this plan	2015-12-31	$4,542,822
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	$3,034,855
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$37,189,765
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$37,189,765
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$2,798,707
Value of total assets at end of year	2015-12-31	$0
Value of total assets at beginning of year	2015-12-31	$38,697,732
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$0
Total interest from all sources	2015-12-31	$265,565
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$281,483
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2015-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$281,483
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2015-12-31	$0
Minimum employer required contribution for this plan year	2015-12-31	$0
Amount contributed by the employer to the plan for this plan year	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
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	$-34,154,910
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$38,697,732
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	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$21,619,651
Interest earned on other investments	2015-12-31	$265,565
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$17,078,081
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-310,900
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	$2,798,707
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$37,189,765
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	2015-12-31	Yes
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	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	SWARTZ RETSON
Accountancy firm EIN	2015-12-31	351509921
2014 : CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY 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	$5,213,358
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$5,947,838
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$5,947,838
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$3,097,680
Value of total assets at end of year	2014-12-31	$38,697,732
Value of total assets at beginning of year	2014-12-31	$39,432,212
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total interest from all sources	2014-12-31	$321,564
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$1,166,997
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2014-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$1,166,997
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	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
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	$-734,480
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$38,697,732
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$39,432,212
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	$21,619,651
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$20,247,987
Interest earned on other investments	2014-12-31	$321,564
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$17,078,081
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$19,184,225
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$627,117
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	$3,097,680
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$5,947,838
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	Yes
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	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	SWARTZ RETSON
Accountancy firm EIN	2014-12-31	351509921
2013 : CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY 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	$4,761,163
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$4,915,648
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$4,915,648
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$0
Value of total assets at end of year	2013-12-31	$39,432,212
Value of total assets at beginning of year	2013-12-31	$39,586,697
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$0
Total interest from all sources	2013-12-31	$341,254
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$415,349
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	$415,349
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	2013-12-31	$134,369
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	$-154,485
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$39,432,212
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$39,586,697
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	$20,247,987
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$15,714,950
Interest earned on other investments	2013-12-31	$341,254
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$19,184,225
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$20,576,735
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$4,004,560
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
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$3,160,643
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$4,915,648
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	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	SWARTZ RETSON
Accountancy firm EIN	2013-12-31	351509921
2012 : CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$42,951
Total income from all sources (including contributions)	2012-12-31	$5,659,584
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$5,932,630
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$5,932,630
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$3,172,367
Value of total assets at end of year	2012-12-31	$39,586,697
Value of total assets at beginning of year	2012-12-31	$39,902,694
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$0
Total interest from all sources	2012-12-31	$383,689
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$241,406
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	$241,406
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$3,160,643
Amount contributed by the employer to the plan for this plan year	2012-12-31	$3,160,643
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$42,951
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$42,951
Other income not declared elsewhere	2012-12-31	$2,626
Total non interest bearing cash at end of year	2012-12-31	$134,369
Total non interest bearing cash at beginning of year	2012-12-31	$3,964
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	$-273,046
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$39,586,697
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$39,859,743
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	$15,714,950
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$14,531,911
Interest earned on other investments	2012-12-31	$383,689
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$20,576,735
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$21,688,543
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$1,859,496
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	$3,172,367
Employer contributions (assets) at end of year	2012-12-31	$3,160,643
Employer contributions (assets) at beginning of year	2012-12-31	$3,635,325
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$5,932,630
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	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	SWARTZ RETSON
Accountancy firm EIN	2012-12-31	351509921
2011 : CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$42,951
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$53,487
Total income from all sources (including contributions)	2011-12-31	$3,862,265
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$3,144,972
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$3,144,972
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$3,692,573
Value of total assets at end of year	2011-12-31	$39,902,694
Value of total assets at beginning of year	2011-12-31	$39,195,937
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$0
Total interest from all sources	2011-12-31	$526,569
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$243,256
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	$243,256
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$3,692,573
Amount contributed by the employer to the plan for this plan year	2011-12-31	$3,692,573
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$42,951
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$53,487
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$42,951
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$53,487
Other income not declared elsewhere	2011-12-31	$4,005
Total non interest bearing cash at end of year	2011-12-31	$3,964
Total non interest bearing cash at beginning of year	2011-12-31	$3,896
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	$717,293
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$39,859,743
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$39,142,450
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	$14,531,911
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$15,292,691
Interest earned on other investments	2011-12-31	$526,569
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$21,688,543
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$20,445,041
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-604,138
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	$3,692,573
Employer contributions (assets) at end of year	2011-12-31	$3,635,325
Employer contributions (assets) at beginning of year	2011-12-31	$3,400,822
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$3,144,972
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	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	SWARTZ RETSON
Accountancy firm EIN	2011-12-31	351509921
2010 : CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$53,487
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$62,456
Total income from all sources (including contributions)	2010-12-31	$5,826,086
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$1,395,346
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,395,346
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$3,400,943
Value of total assets at end of year	2010-12-31	$39,195,937
Value of total assets at beginning of year	2010-12-31	$34,774,166
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$652,776
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$239,025
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$239,025
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$3,400,943
Amount contributed by the employer to the plan for this plan year	2010-12-31	$3,400,943
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$53,487
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$62,456
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$53,487
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$62,456
Total non interest bearing cash at end of year	2010-12-31	$3,896
Total non interest bearing cash at beginning of year	2010-12-31	$4,455
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	$4,430,740
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$39,142,450
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$34,711,710
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	$15,292,691
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$12,708,221
Interest earned on other investments	2010-12-31	$652,776
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$20,445,041
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$18,635,186
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$1,533,342
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	$3,400,943
Employer contributions (assets) at end of year	2010-12-31	$3,400,822
Employer contributions (assets) at beginning of year	2010-12-31	$3,363,848
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,395,346
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	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	SWARTZ RETSON
Accountancy firm EIN	2010-12-31	351509921
2009 : CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$3,465,258
Amount contributed by the employer to the plan for this plan year	2009-12-31	$3,465,258

Form 5500 Responses for CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER

2015: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY 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	Yes
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	Yes
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: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY 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	Yes
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: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY 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	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY 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	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY 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 funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY 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 funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2008: CFNI RETIREMENT BENEFIT PLAN FOR EMPLOYEES OF ST. CATHERINE HOSPITAL AND ST. MARY MEDICAL CENTER 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	Yes
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No

Insurance Providers Used on plan

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

Policy contract number

892639

Policy instance

Insurance contract or identification number	892639
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,197
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,197
Insurance broker organization code?	4
Insurance broker name	LINCOLN FINANCIAL ADVISORS

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

Policy contract number

892639

Policy instance

Insurance contract or identification number	892639
Number of Individuals Covered	816
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $11,306
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,306
Insurance broker organization code?	4
Insurance broker name	LINCOLN FINANCIAL ADVISORS

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

Policy contract number

892639

Policy instance

Insurance contract or identification number	892639
Number of Individuals Covered	904
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $13,771
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,771
Insurance broker organization code?	4
Insurance broker name	LINCOLN FINANCIAL ADVISORS

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

Policy contract number

892639

Policy instance

Insurance contract or identification number	892639
Number of Individuals Covered	973
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $14,800
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,800
Insurance broker organization code?	4
Insurance broker name	LINCOLN FINANCIAL ADVISORS

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

Policy contract number

892639

Policy instance

Insurance contract or identification number	892639
Number of Individuals Covered	1053
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $14,914
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

892639

Policy instance

Insurance contract or identification number	892639
Number of Individuals Covered	1083
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $13,798
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,798
Insurance broker organization code?	4
Insurance broker name	LINCOLN FINANCIAL ADVISORS

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Company Name:	COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC.
Employer identification number (EIN):	311128781
NAIC Classification:	622000
NAIC Description:	Hospitals