401k Plan data: HOLZER HEALTH SYSTEM 403B PLAN plan

HOLZER HEALTH SYSTEM 403B PLAN 401k Plan overview

Plan Name	HOLZER HEALTH SYSTEM 403B PLAN
Plan identification number	002

HOLZER HEALTH SYSTEM 403B PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

HOLZER HEALTH SYSTEM has sponsored the creation of one or more 401k plans.

Company Name: HOLZER HEALTH SYSTEM

Employer identification number (EIN): 311156690

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOLZER HEALTH SYSTEM 403B PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01
002 2021-01-01
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01 LISA HALLEY LISA HALLEY 2018-10-10
002 2016-01-01 LISA HALLEY
002 2015-01-01 LISA HALLEY
002 2014-01-01 LISA HALLEY LISA HALLEY 2015-10-15
002 2013-01-01 LISA HALLEY LISA HALLEY 2014-10-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01
002	2021-01-01
002	2020-01-01
002	2019-01-01
002	2018-01-01
002	2017-01-01	LISA HALLEY	LISA HALLEY	2018-10-10
002	2016-01-01	LISA HALLEY
002	2015-01-01	LISA HALLEY
002	2014-01-01	LISA HALLEY	LISA HALLEY	2015-10-15
002	2013-01-01	LISA HALLEY	LISA HALLEY	2014-10-15

Plan Statistics for HOLZER HEALTH SYSTEM 403B PLAN

401k plan membership statisitcs for HOLZER HEALTH SYSTEM 403B PLAN

Measure Date Value
2022: HOLZER HEALTH SYSTEM 403B PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 2,727
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 2,514
Number of retired or separated participants receiving benefits 2022-01-01 10
Number of other retired or separated participants entitled to future benefits 2022-01-01 226
Total of all active and inactive participants 2022-01-01 2,750
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 5
Total participants 2022-01-01 2,755
Number of participants with account balances 2022-01-01 1,339
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: HOLZER HEALTH SYSTEM 403B PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 2,850
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 2,498
Number of retired or separated participants receiving benefits 2021-01-01 13
Number of other retired or separated participants entitled to future benefits 2021-01-01 213
Total of all active and inactive participants 2021-01-01 2,724
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 3
Total participants 2021-01-01 2,727
Number of participants with account balances 2021-01-01 1,316
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: HOLZER HEALTH SYSTEM 403B PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 2,896
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 2,648
Number of retired or separated participants receiving benefits 2020-01-01 13
Number of other retired or separated participants entitled to future benefits 2020-01-01 185
Total of all active and inactive participants 2020-01-01 2,846
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 4
Total participants 2020-01-01 2,850
Number of participants with account balances 2020-01-01 1,260
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: HOLZER HEALTH SYSTEM 403B PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 2,380
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 2,694
Number of retired or separated participants receiving benefits 2019-01-01 12
Number of other retired or separated participants entitled to future benefits 2019-01-01 187
Total of all active and inactive participants 2019-01-01 2,893
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 3
Total participants 2019-01-01 2,896
Number of participants with account balances 2019-01-01 1,279
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: HOLZER HEALTH SYSTEM 403B PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 3,308
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,972
Number of retired or separated participants receiving benefits 2018-01-01 16
Number of other retired or separated participants entitled to future benefits 2018-01-01 388
Total of all active and inactive participants 2018-01-01 2,376
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 4
Total participants 2018-01-01 2,380
Number of participants with account balances 2018-01-01 1,876
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 55
2017: HOLZER HEALTH SYSTEM 403B PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 2,488
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 2,485
Number of retired or separated participants receiving benefits 2017-01-01 6
Number of other retired or separated participants entitled to future benefits 2017-01-01 237
Total of all active and inactive participants 2017-01-01 2,728
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 2
Total participants 2017-01-01 2,730
Number of participants with account balances 2017-01-01 1,343
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: HOLZER HEALTH SYSTEM 403B PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,549
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 2,153
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 335
Total of all active and inactive participants 2016-01-01 2,488
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 2,488
Number of participants with account balances 2016-01-01 1,360
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: HOLZER HEALTH SYSTEM 403B PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 2,674
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,115
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 425
Total of all active and inactive participants 2015-01-01 1,540
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 1
Total participants 2015-01-01 1,541
Number of participants with account balances 2015-01-01 1,452
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 27
2014: HOLZER HEALTH SYSTEM 403B PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2,970
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 2,285
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 366
Total of all active and inactive participants 2014-01-01 2,651
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 2,651
Number of participants with account balances 2014-01-01 1,606
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 74
2013: HOLZER HEALTH SYSTEM 403B PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,527
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2,718
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 252
Total of all active and inactive participants 2013-01-01 2,970
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 2,970
Number of participants with account balances 2013-01-01 1,728
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 58

Measure	Date	Value
2022: HOLZER HEALTH SYSTEM 403B PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	2,727
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	2,514
Number of retired or separated participants receiving benefits	2022-01-01	10
Number of other retired or separated participants entitled to future benefits	2022-01-01	226
Total of all active and inactive participants	2022-01-01	2,750
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	5
Total participants	2022-01-01	2,755
Number of participants with account balances	2022-01-01	1,339
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: HOLZER HEALTH SYSTEM 403B PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	2,850
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	2,498
Number of retired or separated participants receiving benefits	2021-01-01	13
Number of other retired or separated participants entitled to future benefits	2021-01-01	213
Total of all active and inactive participants	2021-01-01	2,724
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	3
Total participants	2021-01-01	2,727
Number of participants with account balances	2021-01-01	1,316
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: HOLZER HEALTH SYSTEM 403B PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	2,896
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	2,648
Number of retired or separated participants receiving benefits	2020-01-01	13
Number of other retired or separated participants entitled to future benefits	2020-01-01	185
Total of all active and inactive participants	2020-01-01	2,846
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	4
Total participants	2020-01-01	2,850
Number of participants with account balances	2020-01-01	1,260
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: HOLZER HEALTH SYSTEM 403B PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	2,380
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	2,694
Number of retired or separated participants receiving benefits	2019-01-01	12
Number of other retired or separated participants entitled to future benefits	2019-01-01	187
Total of all active and inactive participants	2019-01-01	2,893
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	3
Total participants	2019-01-01	2,896
Number of participants with account balances	2019-01-01	1,279
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: HOLZER HEALTH SYSTEM 403B PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	3,308
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,972
Number of retired or separated participants receiving benefits	2018-01-01	16
Number of other retired or separated participants entitled to future benefits	2018-01-01	388
Total of all active and inactive participants	2018-01-01	2,376
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	4
Total participants	2018-01-01	2,380
Number of participants with account balances	2018-01-01	1,876
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	55
2017: HOLZER HEALTH SYSTEM 403B PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	2,488
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	2,485
Number of retired or separated participants receiving benefits	2017-01-01	6
Number of other retired or separated participants entitled to future benefits	2017-01-01	237
Total of all active and inactive participants	2017-01-01	2,728
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	2
Total participants	2017-01-01	2,730
Number of participants with account balances	2017-01-01	1,343
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: HOLZER HEALTH SYSTEM 403B PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,549
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	2,153
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	335
Total of all active and inactive participants	2016-01-01	2,488
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	2,488
Number of participants with account balances	2016-01-01	1,360
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: HOLZER HEALTH SYSTEM 403B PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	2,674
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,115
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	425
Total of all active and inactive participants	2015-01-01	1,540
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	1
Total participants	2015-01-01	1,541
Number of participants with account balances	2015-01-01	1,452
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	27
2014: HOLZER HEALTH SYSTEM 403B PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2,970
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2,285
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	366
Total of all active and inactive participants	2014-01-01	2,651
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	2,651
Number of participants with account balances	2014-01-01	1,606
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	74
2013: HOLZER HEALTH SYSTEM 403B PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,527
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2,718
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	252
Total of all active and inactive participants	2013-01-01	2,970
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	2,970
Number of participants with account balances	2013-01-01	1,728
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	58

Financial Data on HOLZER HEALTH SYSTEM 403B PLAN

Measure	Date	Value
2022 : HOLZER HEALTH SYSTEM 403B PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-5,963,637
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$4,158,903
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$4,032,732
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$5,614,401
Value of total assets at end of year	2022-12-31	$66,266,351
Value of total assets at beginning of year	2022-12-31	$76,388,891
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$126,171
Total interest from all sources	2022-12-31	$53,108
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$2,387,803
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$2,387,803
Administrative expenses professional fees incurred	2022-12-31	$126,171
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$2,290,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$5,610,449
Participant contributions at end of year	2022-12-31	$554,681
Participant contributions at beginning of year	2022-12-31	$699,932
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2022-12-31	$2,347,127
Assets. Other investments not covered elsewhere at beginning of year	2022-12-31	$3,147,080
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$3,952
Other income not declared elsewhere	2022-12-31	$-493,546
Total non interest bearing cash at end of year	2022-12-31	$558
Total non interest bearing cash at beginning of year	2022-12-31	$163,332
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-10,122,540
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$66,266,351
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$76,388,891
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$54,687,582
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$64,755,852
Interest on participant loans	2022-12-31	$28,601
Interest earned on other investments	2022-12-31	$24,507
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$8,676,403
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$7,622,695
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-13,525,403
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$4,032,732
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	SCHNEIDER DOWNS & CO.,INC
Accountancy firm EIN	2022-12-31	251408703
2021 : HOLZER HEALTH SYSTEM 403B PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$15,220,686
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$5,290,621
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$5,179,705
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$5,704,749
Value of total assets at end of year	2021-12-31	$76,388,891
Value of total assets at beginning of year	2021-12-31	$66,458,826
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$110,916
Total interest from all sources	2021-12-31	$248,121
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$2,865,995
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$2,865,995
Administrative expenses professional fees incurred	2021-12-31	$110,916
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$2,290,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$5,446,740
Participant contributions at end of year	2021-12-31	$699,932
Participant contributions at beginning of year	2021-12-31	$773,629
Participant contributions at end of year	2021-12-31	$0
Participant contributions at beginning of year	2021-12-31	$144,559
Assets. Other investments not covered elsewhere at end of year	2021-12-31	$3,147,080
Assets. Other investments not covered elsewhere at beginning of year	2021-12-31	$1,934,919
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$258,009
Other income not declared elsewhere	2021-12-31	$183,738
Total non interest bearing cash at end of year	2021-12-31	$163,332
Total non interest bearing cash at beginning of year	2021-12-31	$1,407
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$9,930,065
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$76,388,891
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$66,458,826
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$64,755,852
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$55,097,583
Interest on participant loans	2021-12-31	$33,869
Interest earned on other investments	2021-12-31	$214,252
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$7,622,695
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$8,506,729
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$6,218,083
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$5,179,705
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	SCHNEIDER DOWNS & CO., INC
Accountancy firm EIN	2021-12-31	251408703
2020 : HOLZER HEALTH SYSTEM 403B PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$13,249,620
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$3,825,477
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$3,701,512
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$5,160,038
Value of total assets at end of year	2020-12-31	$66,458,826
Value of total assets at beginning of year	2020-12-31	$57,034,683
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$123,965
Total interest from all sources	2020-12-31	$272,798
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$1,626,578
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$1,626,578
Administrative expenses professional fees incurred	2020-12-31	$123,965
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$2,290,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$5,018,893
Participant contributions at end of year	2020-12-31	$773,629
Participant contributions at beginning of year	2020-12-31	$656,741
Participant contributions at end of year	2020-12-31	$144,559
Assets. Other investments not covered elsewhere at end of year	2020-12-31	$1,934,919
Assets. Other investments not covered elsewhere at beginning of year	2020-12-31	$1,624,497
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$141,145
Other income not declared elsewhere	2020-12-31	$312,285
Total non interest bearing cash at end of year	2020-12-31	$1,407
Total non interest bearing cash at beginning of year	2020-12-31	$117,961
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$9,424,143
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$66,458,826
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$57,034,683
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$55,097,583
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$46,511,701
Interest on participant loans	2020-12-31	$37,506
Interest earned on other investments	2020-12-31	$235,292
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$8,506,729
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$8,123,783
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$5,877,921
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$3,701,512
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	SCHNEIDER DOWNS & CO., INC.
Accountancy firm EIN	2020-12-31	251408703
2019 : HOLZER HEALTH SYSTEM 403B PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$15,241,690
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$5,139,452
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$5,049,730
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$5,174,118
Value of total assets at end of year	2019-12-31	$57,034,683
Value of total assets at beginning of year	2019-12-31	$46,932,445
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$89,722
Total interest from all sources	2019-12-31	$276,454
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$1,561,991
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	$1,561,991
Administrative expenses professional fees incurred	2019-12-31	$89,722
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$2,290,000
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	$5,036,148
Participant contributions at end of year	2019-12-31	$656,741
Participant contributions at beginning of year	2019-12-31	$670,283
Assets. Other investments not covered elsewhere at end of year	2019-12-31	$1,624,497
Assets. Other investments not covered elsewhere at beginning of year	2019-12-31	$1,209,026
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$133,480
Other income not declared elsewhere	2019-12-31	$424,286
Total non interest bearing cash at end of year	2019-12-31	$117,961
Total non interest bearing cash at beginning of year	2019-12-31	$275,711
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$10,102,238
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$57,034,683
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$46,932,445
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	$46,511,701
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$37,331,499
Interest on participant loans	2019-12-31	$36,324
Interest earned on other investments	2019-12-31	$240,130
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$8,123,783
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$7,445,926
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$7,804,841
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	$4,490
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$5,049,730
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	SCHNEIDER DOWNS & CO.,INC.
Accountancy firm EIN	2019-12-31	251408703
2018 : HOLZER HEALTH SYSTEM 403B PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$3,050,455
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$3,579,726
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$3,540,195
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$5,270,125
Value of total assets at end of year	2018-12-31	$46,932,445
Value of total assets at beginning of year	2018-12-31	$47,461,716
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$39,531
Total interest from all sources	2018-12-31	$229,647
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$1,671,890
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	$1,671,890
Administrative expenses professional fees incurred	2018-12-31	$39,531
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$2,290,000
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	$269,819
Participant contributions at end of year	2018-12-31	$670,283
Participant contributions at beginning of year	2018-12-31	$579,432
Participant contributions at beginning of year	2018-12-31	$20,018
Assets. Other investments not covered elsewhere at end of year	2018-12-31	$1,209,026
Assets. Other investments not covered elsewhere at beginning of year	2018-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$0
Other income not declared elsewhere	2018-12-31	$-106,498
Total non interest bearing cash at end of year	2018-12-31	$275,711
Total non interest bearing cash at beginning of year	2018-12-31	$274,568
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	$-529,271
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$46,932,445
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$47,461,716
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	$37,331,499
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$38,399,254
Interest on participant loans	2018-12-31	$27,699
Interest earned on other investments	2018-12-31	$201,948
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$257,869
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$257,869
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$7,445,926
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$7,930,575
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-4,014,709
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	$5,000,306
Employer contributions (assets) at beginning of year	2018-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$3,540,195
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	SCHNEIDER DOWNS & CO., INC.
Accountancy firm EIN	2018-12-31	251408703
2017 : HOLZER HEALTH SYSTEM 403B PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$11,364,196
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$3,861,086
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$3,805,539
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$5,253,383
Value of total assets at end of year	2017-12-31	$47,461,716
Value of total assets at beginning of year	2017-12-31	$39,958,606
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$55,547
Total interest from all sources	2017-12-31	$16,677
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$1,274,739
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	$1,274,739
Administrative expenses professional fees incurred	2017-12-31	$41,547
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$2,290,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$4,918,406
Participant contributions at end of year	2017-12-31	$579,432
Participant contributions at beginning of year	2017-12-31	$538,743
Participant contributions at end of year	2017-12-31	$20,018
Participant contributions at beginning of year	2017-12-31	$263,951
Assets. Other investments not covered elsewhere at end of year	2017-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$334,977
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$0
Total non interest bearing cash at end of year	2017-12-31	$274,568
Total non interest bearing cash at beginning of year	2017-12-31	$34,561
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$7,503,110
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$47,461,716
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$39,958,606
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	$38,399,254
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$30,128,337
Interest on participant loans	2017-12-31	$16,677
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$257,869
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$7,930,575
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$8,993,014
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$4,819,397
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
Employer contributions (assets) at end of year	2017-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$3,805,539
Contract administrator fees	2017-12-31	$14,000
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	SCHNEIDER DOWNS AND CO., INC.
Accountancy firm EIN	2017-12-31	251408703
2016 : HOLZER HEALTH SYSTEM 403B PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$7,494,091
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$5,061,536
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$4,977,427
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$4,837,933
Value of total assets at end of year	2016-12-31	$39,958,606
Value of total assets at beginning of year	2016-12-31	$37,526,051
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$84,109
Total interest from all sources	2016-12-31	$275,282
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$826,948
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	$826,948
Administrative expenses professional fees incurred	2016-12-31	$11,621
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$2,290,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$4,719,884
Participant contributions at end of year	2016-12-31	$538,743
Participant contributions at beginning of year	2016-12-31	$540,530
Participant contributions at end of year	2016-12-31	$263,951
Participant contributions at beginning of year	2016-12-31	$397,304
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$118,049
Other income not declared elsewhere	2016-12-31	$6,122
Total non interest bearing cash at end of year	2016-12-31	$34,561
Total non interest bearing cash at beginning of year	2016-12-31	$188,699
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
Income. Non cash contributions	2016-12-31	$0
Value of net income/loss	2016-12-31	$2,432,555
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$39,958,606
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$37,526,051
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Investment advisory and management fees	2016-12-31	$72,164
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$30,128,337
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$28,159,894
Interest on participant loans	2016-12-31	$19,189
Interest earned on other investments	2016-12-31	$256,093
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$8,993,014
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$8,239,624
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$1,547,806
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	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$4,977,427
Contract administrator fees	2016-12-31	$324
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	SCHNEIDER DOWNS AND CO INC
Accountancy firm EIN	2016-12-31	251408703
2015 : HOLZER HEALTH SYSTEM 403B PLAN 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	$6,364,118
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$4,158,762
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$4,073,362
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$5,950,806
Value of total assets at end of year	2015-12-31	$37,526,051
Value of total assets at beginning of year	2015-12-31	$35,320,695
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$85,400
Total interest from all sources	2015-12-31	$278,720
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$1,144,811
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$1,144,811
Administrative expenses professional fees incurred	2015-12-31	$10,554
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$2,290,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$5,866,222
Participant contributions at end of year	2015-12-31	$540,530
Participant contributions at beginning of year	2015-12-31	$684,212
Participant contributions at end of year	2015-12-31	$397,304
Participant contributions at beginning of year	2015-12-31	$197,357
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$84,584
Other income not declared elsewhere	2015-12-31	$5,272
Total non interest bearing cash at end of year	2015-12-31	$188,699
Total non interest bearing cash at beginning of year	2015-12-31	$13,755
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	$2,205,356
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$37,526,051
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$35,320,695
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Investment advisory and management fees	2015-12-31	$74,505
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$28,159,894
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$26,460,589
Interest on participant loans	2015-12-31	$20,720
Interest earned on other investments	2015-12-31	$258,000
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$8,239,624
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$7,964,782
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-1,015,491
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	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$4,073,362
Contract administrator fees	2015-12-31	$341
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	SCHNEIDER DOWNS AND CO INC
Accountancy firm EIN	2015-12-31	251408703
2014 : HOLZER HEALTH SYSTEM 403B PLAN 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	$8,163,802
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$2,163,533
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$2,045,484
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$6,127,944
Value of total assets at end of year	2014-12-31	$35,320,695
Value of total assets at beginning of year	2014-12-31	$29,320,426
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$118,049
Total interest from all sources	2014-12-31	$284,518
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$1,180,032
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$1,180,032
Administrative expenses professional fees incurred	2014-12-31	$13,042
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$2,290,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$6,119,820
Participant contributions at end of year	2014-12-31	$684,212
Participant contributions at beginning of year	2014-12-31	$702,096
Participant contributions at end of year	2014-12-31	$197,357
Participant contributions at beginning of year	2014-12-31	$196,704
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$8,124
Other income not declared elsewhere	2014-12-31	$15,154
Total non interest bearing cash at end of year	2014-12-31	$13,755
Total non interest bearing cash at beginning of year	2014-12-31	$902
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	$6,000,269
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$35,320,695
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$29,320,426
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Investment advisory and management fees	2014-12-31	$104,665
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$26,460,589
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$20,613,611
Interest on participant loans	2014-12-31	$27,539
Interest earned on other investments	2014-12-31	$256,979
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$7,964,782
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$7,807,113
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$556,154
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$2,045,484
Contract administrator fees	2014-12-31	$342
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	SCHNEIDER DOWNS AND CO INC
Accountancy firm EIN	2014-12-31	251408703
2013 : HOLZER HEALTH SYSTEM 403B PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total transfer of assets to this plan	2013-12-31	$4,885,863
Total transfer of assets from this plan	2013-12-31	$5,918
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	$10,449,952
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$1,717,474
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,669,919
Value of total corrective distributions	2013-12-31	$99
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$6,557,438
Value of total assets at end of year	2013-12-31	$29,320,426
Value of total assets at beginning of year	2013-12-31	$15,708,003
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$47,456
Total interest from all sources	2013-12-31	$301,147
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$712,108
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	$712,108
Administrative expenses professional fees incurred	2013-12-31	$7,380
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$6,203,515
Participant contributions at end of year	2013-12-31	$702,096
Participant contributions at beginning of year	2013-12-31	$454,840
Participant contributions at end of year	2013-12-31	$196,704
Participant contributions at beginning of year	2013-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$353,923
Other income not declared elsewhere	2013-12-31	$2,887
Total non interest bearing cash at end of year	2013-12-31	$902
Total non interest bearing cash at beginning of year	2013-12-31	$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	2013-12-31	No
Value of net income/loss	2013-12-31	$8,732,478
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$29,320,426
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$15,708,003
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Investment advisory and management fees	2013-12-31	$40,076
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$20,613,611
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$10,021,566
Interest on participant loans	2013-12-31	$25,094
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$276,053
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$7,807,113
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$5,231,597
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$2,876,372
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,669,919
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	Yes
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	SCHNEIDER DOWNS AND CO INC
Accountancy firm EIN	2013-12-31	251408703

Form 5500 Responses for HOLZER HEALTH SYSTEM 403B PLAN

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

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

743299-02

Policy instance

Insurance contract or identification number	743299-02
Number of Individuals Covered	10
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

743299-01

Policy instance

Insurance contract or identification number	743299-01
Number of Individuals Covered	8
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

B01423

Policy instance

Insurance contract or identification number	B01423
Number of Individuals Covered	9
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

B01423

Policy instance

Insurance contract or identification number	B01423
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

743299-01

Policy instance

Insurance contract or identification number	743299-01
Number of Individuals Covered	9
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

743299-02

Policy instance

Insurance contract or identification number	743299-02
Number of Individuals Covered	10
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

080021

Policy instance

Insurance contract or identification number	080021
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

082361

Policy instance

Insurance contract or identification number	082361
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

082361

Policy instance

Insurance contract or identification number	082361
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

080021

Policy instance

Insurance contract or identification number	080021
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

B01423

Policy instance

Insurance contract or identification number	B01423
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

B01423

Policy instance

Insurance contract or identification number	B01423
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

080021

Policy instance

Insurance contract or identification number	080021
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

082361

Policy instance

Insurance contract or identification number	082361
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

082361

Policy instance

Insurance contract or identification number	082361
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

B01423

Policy instance

Insurance contract or identification number	B01423
Number of Individuals Covered	194
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

080021

Policy instance

Insurance contract or identification number	080021
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

082361

Policy instance

Insurance contract or identification number	082361
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

080021

Policy instance

Insurance contract or identification number	080021
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

K00066

Policy instance

Insurance contract or identification number	K00066
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

K00057

Policy instance

Insurance contract or identification number	K00057
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

B01423

Policy instance

Insurance contract or identification number	B01423
Number of Individuals Covered	8
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	HOLZER HEALTH SYSTEM
Employer identification number (EIN):	311156690
NAIC Classification:	622000
NAIC Description:	Hospitals