401k Plan data: CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN plan

CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN 401k Plan overview

Plan Name	CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN
Plan identification number	012

CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY 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.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

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

Company Name: ASCENSION HEALTHCARE

Employer identification number (EIN): 311662309

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Additional information about ASCENSION HEALTHCARE

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2000-02-14

Company Identification Number: 0013101407

Legal Registered Office Address: 211 E 7TH ST STE 620

AUSTIN
United States of America (USA)
78701

More information about ASCENSION HEALTHCARE

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
012 2022-01-01 CHRIS BELCHER 2023-07-25
012 2021-01-01 CHRIS BELCHER 2022-06-20
012 2020-01-01
012 2019-01-01
012 2018-01-01 CHRIS BELCHER
012 2017-01-01 CHRIS BELCHER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
012	2022-01-01	CHRIS BELCHER	2023-07-25
012	2021-01-01	CHRIS BELCHER	2022-06-20
012	2020-01-01
012	2019-01-01
012	2018-01-01	CHRIS BELCHER
012	2017-01-01	CHRIS BELCHER

Plan Statistics for CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN

401k plan membership statisitcs for CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN

Measure Date Value
2020: CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 49
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 50
Total of all active and inactive participants 2020-01-01 99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 99
Number of participants with account balances 2020-01-01 96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 54
Number of other retired or separated participants entitled to future benefits 2019-01-01 55
Total of all active and inactive participants 2019-01-01 109
Total participants 2019-01-01 109
Number of participants with account balances 2019-01-01 104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 115
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 54
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 58
Total of all active and inactive participants 2018-01-01 112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 112
Number of participants with account balances 2018-01-01 112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 172
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 57
Number of other retired or separated participants entitled to future benefits 2017-01-01 58
Total of all active and inactive participants 2017-01-01 115
Total participants 2017-01-01 115
Number of participants with account balances 2017-01-01 115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0

Measure	Date	Value
2020: CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	49
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	50
Total of all active and inactive participants	2020-01-01	99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	99
Number of participants with account balances	2020-01-01	96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	54
Number of other retired or separated participants entitled to future benefits	2019-01-01	55
Total of all active and inactive participants	2019-01-01	109
Total participants	2019-01-01	109
Number of participants with account balances	2019-01-01	104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	115
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	54
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	58
Total of all active and inactive participants	2018-01-01	112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	112
Number of participants with account balances	2018-01-01	112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	172
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	57
Number of other retired or separated participants entitled to future benefits	2017-01-01	58
Total of all active and inactive participants	2017-01-01	115
Total participants	2017-01-01	115
Number of participants with account balances	2017-01-01	115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0

Financial Data on CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN

Measure	Date	Value
2020 : CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY 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	$777,490
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$205,189
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$202,789
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$0
Value of total assets at end of year	2020-12-31	$5,121,132
Value of total assets at beginning of year	2020-12-31	$4,548,831
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$2,400
Total interest from all sources	2020-12-31	$21,948
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$20,000,000
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
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$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	2020-12-31	No
Value of net income/loss	2020-12-31	$572,301
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$5,121,132
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$4,548,831
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	$4,484,993
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$3,909,133
Interest earned on other investments	2020-12-31	$21,948
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$636,139
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$639,698
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$755,542
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	$202,789
Contract administrator fees	2020-12-31	$2,400
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	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2020-12-31	410746749
2019 : CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY 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	$910,757
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$928,707
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$925,945
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$23,699
Value of total assets at end of year	2019-12-31	$4,548,831
Value of total assets at beginning of year	2019-12-31	$4,566,781
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$2,762
Total interest from all sources	2019-12-31	$25,459
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$20,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$23,699
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$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	2019-12-31	No
Value of net income/loss	2019-12-31	$-17,950
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$4,548,831
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,566,781
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	$3,909,133
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,819,325
Interest earned on other investments	2019-12-31	$25,459
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$639,698
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$747,456
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$861,599
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$925,945
Contract administrator fees	2019-12-31	$2,762
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	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2019-12-31	410746749
2018 : CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY 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	$-220,301
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$319,124
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$316,524
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$0
Value of total assets at end of year	2018-12-31	$4,566,781
Value of total assets at beginning of year	2018-12-31	$5,106,206
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$2,600
Total interest from all sources	2018-12-31	$26,127
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$20,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$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	2018-12-31	No
Value of net income/loss	2018-12-31	$-539,425
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$4,566,781
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$5,106,206
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	$3,819,325
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$4,360,297
Interest earned on other investments	2018-12-31	$26,127
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$747,456
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$745,909
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-246,428
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$316,524
Contract administrator fees	2018-12-31	$2,600
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	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2018-12-31	410746749
2017 : CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY 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	$707,849
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$268,306
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$265,402
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$0
Value of total assets at end of year	2017-12-31	$5,106,206
Value of total assets at beginning of year	2017-12-31	$4,666,663
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$2,904
Total interest from all sources	2017-12-31	$28,870
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$20,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Participant contributions at end of year	2017-12-31	$0
Participant contributions at beginning of year	2017-12-31	$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	2017-12-31	No
Value of net income/loss	2017-12-31	$439,543
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$5,106,206
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$4,666,663
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	$4,360,297
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$3,820,458
Interest earned on other investments	2017-12-31	$28,870
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$745,909
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$846,205
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$678,979
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$265,402
Contract administrator fees	2017-12-31	$2,904
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	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2017-12-31	410746749

Form 5500 Responses for CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY PLAN

2020: CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY 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: CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY 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: CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY 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: CALUMET MEDICAL CENTER, INC. 403(B) TAX DEFERRED ANNUITY 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

Insurance Providers Used on plan

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

Policy contract number

CR15006

Policy instance

Insurance contract or identification number	CR15006
Number of Individuals Covered	96
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,588
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
Commission paid to Insurance Broker	USD $8,588
Insurance broker organization code?	4

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

Policy contract number

CR15006

Policy instance

Insurance contract or identification number	CR15006
Number of Individuals Covered	104
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9,103
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
Commission paid to Insurance Broker	USD $9,103
Insurance broker organization code?	4

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

Policy contract number

CR15006

Policy instance

Insurance contract or identification number	CR15006
Number of Individuals Covered	112
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $10,688
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
Commission paid to Insurance Broker	USD $10,688
Insurance broker organization code?	4

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

Policy contract number

CR15006

Policy instance

Insurance contract or identification number	CR15006
Number of Individuals Covered	115
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $10,266
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
Commission paid to Insurance Broker	USD $10,266
Insurance broker organization code?	4
Insurance broker name	LPL FINANCIAL CORPORATION

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Company Name:	ASCENSION HEALTHCARE
Employer identification number (EIN):	311662309
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2000-02-14
Company Identification Number:	0013101407
Legal Registered Office Address:	211 E 7TH ST STE 620 AUSTIN United States of America (USA) 78701