O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 401k Plan overview

Plan Name	O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN
Plan identification number	001

O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1. Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met. 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. 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

SHELTERING ARMS HOSPITAL, INC has sponsored the creation of one or more 401k plans.

Company Name:	SHELTERING ARMS HOSPITAL, INC
Employer identification number (EIN):	314446959
NAIC Classification:	622000
NAIC Description:	Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-06-01
001	2019-06-01
001	2019-01-01
001	2018-06-01
001	2018-01-01
001	2017-06-01	RICHARD HOBACK
001	2017-01-01	RICHARD HOBACK
001	2016-06-01	BRIANNA EDWARDS
001	2016-01-01	ETHAN FRANK-COLLINS
001	2015-06-01	BRIANNA EDWARDS
001	2015-01-01	ETHAN FRANK-COLLINS
001	2014-06-01	BRIANNA EDWARDS
001	2014-01-01	BRIANNA EDWARDS
001	2013-01-01	BRIANNA EDWARDS
001	2012-01-01	BRIANNA EDWARDS		BRIANNA EDWARDS	2013-10-10
001	2011-01-01	BRIANNA EDWARDS		BRIANNA EDWARDS	2012-10-15
001	2009-01-01	BRIANNA EDWARDS

Plan Statistics for O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN

401k plan membership statisitcs for O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN

Measure	Date	Value
2022: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	563
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	425
Number of retired or separated participants receiving benefits	2022-01-01	3
Number of other retired or separated participants entitled to future benefits	2022-01-01	166
Total of all active and inactive participants	2022-01-01	594
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	1
Total participants	2022-01-01	595
Number of participants with account balances	2022-01-01	582
2021: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	580
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	415
Number of retired or separated participants receiving benefits	2021-01-01	3
Number of other retired or separated participants entitled to future benefits	2021-01-01	144
Total of all active and inactive participants	2021-01-01	562
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	1
Total participants	2021-01-01	563
Number of participants with account balances	2021-01-01	549
2020: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	698
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	410
Number of retired or separated participants receiving benefits	2020-01-01	7
Number of other retired or separated participants entitled to future benefits	2020-01-01	163
Total of all active and inactive participants	2020-01-01	580
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	580
Number of participants with account balances	2020-01-01	565
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-06-01	193
Total number of active participants reported on line 7a of the Form 5500	2019-06-01	0
Number of retired or separated participants receiving benefits	2019-06-01	0
Number of other retired or separated participants entitled to future benefits	2019-06-01	0
Total of all active and inactive participants	2019-06-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-06-01	0
Total participants	2019-06-01	0
Number of participants with account balances	2019-06-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-06-01	0
Total participants, beginning-of-year	2019-01-01	724
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	532
Number of retired or separated participants receiving benefits	2019-01-01	2
Number of other retired or separated participants entitled to future benefits	2019-01-01	163
Total of all active and inactive participants	2019-01-01	697
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	1
Total participants	2019-01-01	698
Number of participants with account balances	2019-01-01	681
2018: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2018 401k membership
Total participants, beginning-of-year	2018-06-01	205
Total number of active participants reported on line 7a of the Form 5500	2018-06-01	106
Number of retired or separated participants receiving benefits	2018-06-01	6
Number of other retired or separated participants entitled to future benefits	2018-06-01	78
Total of all active and inactive participants	2018-06-01	190
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-06-01	3
Total participants	2018-06-01	193
Number of participants with account balances	2018-06-01	193
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-06-01	0
Total participants, beginning-of-year	2018-01-01	723
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	550
Number of retired or separated participants receiving benefits	2018-01-01	4
Number of other retired or separated participants entitled to future benefits	2018-01-01	170
Total of all active and inactive participants	2018-01-01	724
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	724
Number of participants with account balances	2018-01-01	708
2017: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-06-01	200
Total number of active participants reported on line 7a of the Form 5500	2017-06-01	111
Number of retired or separated participants receiving benefits	2017-06-01	6
Number of other retired or separated participants entitled to future benefits	2017-06-01	85
Total of all active and inactive participants	2017-06-01	202
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-06-01	3
Total participants	2017-06-01	205
Number of participants with account balances	2017-06-01	205
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-06-01	0
Total participants, beginning-of-year	2017-01-01	657
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	552
Number of retired or separated participants receiving benefits	2017-01-01	2
Number of other retired or separated participants entitled to future benefits	2017-01-01	169
Total of all active and inactive participants	2017-01-01	723
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	723
Number of participants with account balances	2017-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-06-01	238
Total number of active participants reported on line 7a of the Form 5500	2016-06-01	105
Number of retired or separated participants receiving benefits	2016-06-01	5
Number of other retired or separated participants entitled to future benefits	2016-06-01	89
Total of all active and inactive participants	2016-06-01	199
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-06-01	1
Total participants	2016-06-01	200
Number of participants with account balances	2016-06-01	200
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-06-01	0
Total participants, beginning-of-year	2016-01-01	755
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	396
Number of retired or separated participants receiving benefits	2016-01-01	6
Number of other retired or separated participants entitled to future benefits	2016-01-01	251
Total of all active and inactive participants	2016-01-01	653
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	4
Total participants	2016-01-01	657
Number of participants with account balances	2016-01-01	656
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-06-01	173
Number of retired or separated participants receiving benefits	2015-06-01	5
Number of other retired or separated participants entitled to future benefits	2015-06-01	109
Total of all active and inactive participants	2015-06-01	114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-06-01	1
Total participants	2015-06-01	115
Number of participants with account balances	2015-06-01	238
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-06-01	0
Total participants, beginning-of-year	2015-01-01	690
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	538
Number of retired or separated participants receiving benefits	2015-01-01	6
Number of other retired or separated participants entitled to future benefits	2015-01-01	210
Total of all active and inactive participants	2015-01-01	754
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	1
Total participants	2015-01-01	755
Number of participants with account balances	2015-01-01	586
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	177
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	143
Number of retired or separated participants receiving benefits	2014-06-01	5
Number of other retired or separated participants entitled to future benefits	2014-06-01	24
Total of all active and inactive participants	2014-06-01	172
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-06-01	1
Total participants	2014-06-01	173
Number of participants with account balances	2014-06-01	173
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-06-01	0
Total participants, beginning-of-year	2014-01-01	693
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	490
Number of retired or separated participants receiving benefits	2014-01-01	6
Number of other retired or separated participants entitled to future benefits	2014-01-01	193
Total of all active and inactive participants	2014-01-01	689
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	1
Total participants	2014-01-01	690
Number of participants with account balances	2014-01-01	561
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	578
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	472
Number of retired or separated participants receiving benefits	2013-01-01	8
Number of other retired or separated participants entitled to future benefits	2013-01-01	213
Total of all active and inactive participants	2013-01-01	693
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	693
Number of participants with account balances	2013-01-01	584
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	571
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	441
Number of retired or separated participants receiving benefits	2012-01-01	5
Number of other retired or separated participants entitled to future benefits	2012-01-01	132
Total of all active and inactive participants	2012-01-01	578
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	578
Number of participants with account balances	2012-01-01	543
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	511
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	423
Number of retired or separated participants receiving benefits	2011-01-01	5
Number of other retired or separated participants entitled to future benefits	2011-01-01	143
Total of all active and inactive participants	2011-01-01	571
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	571
Number of participants with account balances	2011-01-01	550
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	538
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	417
Number of retired or separated participants receiving benefits	2009-01-01	5
Number of other retired or separated participants entitled to future benefits	2009-01-01	126
Total of all active and inactive participants	2009-01-01	548
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	548
Number of participants with account balances	2009-01-01	556
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN

Measure	Date	Value
2022 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY 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	$-3,912,883
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$3,309,179
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$3,229,654
Expenses. Certain deemed distributions of participant loans	2022-12-31	$67,587
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,946,731
Value of total assets at end of year	2022-12-31	$37,970,130
Value of total assets at beginning of year	2022-12-31	$45,192,192
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$11,938
Total interest from all sources	2022-12-31	$295,000
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$1,042,506
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	$1,042,506
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$956,446
Participant contributions at end of year	2022-12-31	$518,062
Participant contributions at beginning of year	2022-12-31	$710,776
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$14,589
Administrative expenses (other) incurred	2022-12-31	$4,306
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	$-7,222,062
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$37,970,130
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$45,192,192
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
Investment advisory and management fees	2022-12-31	$7,632
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$8,781,122
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$11,154,876
Interest on participant loans	2022-12-31	$23,526
Interest earned on other investments	2022-12-31	$271,474
Value of interest in common/collective trusts at end of year	2022-12-31	$19,182,160
Value of interest in common/collective trusts at beginning of year	2022-12-31	$23,888,769
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$9,488,786
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$9,437,771
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-7,197,120
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	$975,696
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$3,229,654
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	2022-12-31	Yes
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	PLANTE & MORAN
Accountancy firm EIN	2022-12-31	381357951
2021 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY 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	$6,257,792
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$3,119,213
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$3,093,496
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$1,845,092
Value of total assets at end of year	2021-12-31	$45,192,192
Value of total assets at beginning of year	2021-12-31	$42,053,613
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$25,717
Total interest from all sources	2021-12-31	$308,640
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$1,482,817
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	$1,482,817
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	Yes
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	$879,793
Participant contributions at end of year	2021-12-31	$710,776
Participant contributions at beginning of year	2021-12-31	$669,250
Assets. Other investments not covered elsewhere at end of year	2021-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2021-12-31	$5,065,852
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$6,845
Administrative expenses (other) incurred	2021-12-31	$19,088
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	$3,138,579
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$45,192,192
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$42,053,613
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
Investment advisory and management fees	2021-12-31	$6,629
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$11,154,876
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$9,254,752
Interest on participant loans	2021-12-31	$28,772
Interest earned on other investments	2021-12-31	$279,868
Value of interest in common/collective trusts at end of year	2021-12-31	$23,888,769
Value of interest in common/collective trusts at beginning of year	2021-12-31	$22,926,087
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$9,437,771
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$4,137,672
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$2,621,243
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	$958,454
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$3,093,496
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	2021-12-31	Yes
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	PLANTE & MORAN
Accountancy firm EIN	2021-12-31	381357951
2020 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED 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	$7,705,255
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$2,208,863
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$2,151,452
Expenses. Certain deemed distributions of participant loans	2020-12-31	$34,947
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$2,679,146
Value of total assets at end of year	2020-12-31	$42,053,613
Value of total assets at beginning of year	2020-12-31	$36,557,221
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$22,464
Total interest from all sources	2020-12-31	$509,122
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$754,536
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	$754,536
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	Yes
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	$1,350,480
Participant contributions at end of year	2020-12-31	$669,250
Participant contributions at beginning of year	2020-12-31	$847,546
Assets. Other investments not covered elsewhere at end of year	2020-12-31	$5,065,852
Assets. Other investments not covered elsewhere at beginning of year	2020-12-31	$4,857,017
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$24,291
Other income not declared elsewhere	2020-12-31	$107,985
Administrative expenses (other) incurred	2020-12-31	$19,128
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	$5,496,392
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$42,053,613
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$36,557,221
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
Investment advisory and management fees	2020-12-31	$3,336
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$9,254,752
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$7,224,341
Interest on participant loans	2020-12-31	$34,296
Interest earned on other investments	2020-12-31	$474,826
Value of interest in common/collective trusts at end of year	2020-12-31	$22,926,087
Value of interest in common/collective trusts at beginning of year	2020-12-31	$19,506,059
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$4,137,672
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$4,122,258
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$3,654,466
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
Contributions received in cash from employer	2020-12-31	$1,304,375
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$2,151,452
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	2020-12-31	Yes
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	PLANTE & MORAN
Accountancy firm EIN	2020-12-31	381357951
Total transfer of assets from this plan	2020-02-03	$3,496,967
Total income from all sources (including contributions)	2020-02-03	$196,928
Total of all expenses incurred	2020-02-03	$214,587
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-02-03	$203,180
Value of total assets at end of year	2020-02-03	$0
Value of total assets at beginning of year	2020-02-03	$3,514,626
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-02-03	$11,407
Total interest from all sources	2020-02-03	$48,116
Total dividends received (eg from common stock, registered investment company shares)	2020-02-03	$6,092
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-02-03	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2020-02-03	$0
Total dividends received from registered investment company shares (eg mutual funds)	2020-02-03	$6,092
Was this plan covered by a fidelity bond	2020-02-03	Yes
Value of fidelity bond cover	2020-02-03	$10,000,000
If this is an individual account plan, was there a blackout period	2020-02-03	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-02-03	$0
Were there any nonexempt tranactions with any party-in-interest	2020-02-03	No
Participant contributions at end of year	2020-02-03	$0
Participant contributions at beginning of year	2020-02-03	$50,765
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-02-03	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-02-03	$645
Administrative expenses (other) incurred	2020-02-03	$11,407
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-02-03	No
Value of net income/loss	2020-02-03	$-17,659
Value of net assets at end of year (total assets less liabilities)	2020-02-03	$0
Value of net assets at beginning of year (total assets less liabilities)	2020-02-03	$3,514,626
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-02-03	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-02-03	No
Were any leases to which the plan was party in default or uncollectible	2020-02-03	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-02-03	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-02-03	$1,374,824
Value of interest in pooled separate accounts at end of year	2020-02-03	$0
Value of interest in pooled separate accounts at beginning of year	2020-02-03	$1,544
Interest on participant loans	2020-02-03	$901
Interest earned on other investments	2020-02-03	$47,215
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-02-03	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-02-03	$2,086,848
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-02-03	$142,690
Net investment gain/loss from pooled separate accounts	2020-02-03	$30
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-02-03	No
Was there a failure to transmit to the plan any participant contributions	2020-02-03	No
Has the plan failed to provide any benefit when due under the plan	2020-02-03	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-02-03	$203,180
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	2020-02-03	No
Did the plan have assets held for investment	2020-02-03	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-02-03	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-02-03	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-02-03	Yes
Opinion of an independent qualified public accountant for this plan	2020-02-03	Disclaimer
Accountancy firm name	2020-02-03	PLANTE & MORGAN, PLLC
Accountancy firm EIN	2020-02-03	388135795
Total transfer of assets from this plan	2020-01-31	$3,496,967
Total income from all sources (including contributions)	2020-01-31	$196,928
Total of all expenses incurred	2020-01-31	$214,587
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-01-31	$203,180
Value of total assets at end of year	2020-01-31	$0
Value of total assets at beginning of year	2020-01-31	$3,514,626
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-01-31	$11,407
Total interest from all sources	2020-01-31	$48,116
Total dividends received (eg from common stock, registered investment company shares)	2020-01-31	$6,092
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-01-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2020-01-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2020-01-31	$6,092
Was this plan covered by a fidelity bond	2020-01-31	Yes
Value of fidelity bond cover	2020-01-31	$10,000,000
If this is an individual account plan, was there a blackout period	2020-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-01-31	No
Participant contributions at end of year	2020-01-31	$0
Participant contributions at beginning of year	2020-01-31	$50,765
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-01-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-01-31	$645
Administrative expenses (other) incurred	2020-01-31	$11,407
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-01-31	No
Value of net income/loss	2020-01-31	$-17,659
Value of net assets at end of year (total assets less liabilities)	2020-01-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2020-01-31	$3,514,626
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-01-31	No
Were any leases to which the plan was party in default or uncollectible	2020-01-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-01-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-01-31	$1,374,824
Value of interest in pooled separate accounts at end of year	2020-01-31	$0
Value of interest in pooled separate accounts at beginning of year	2020-01-31	$1,544
Interest on participant loans	2020-01-31	$901
Interest earned on other investments	2020-01-31	$47,215
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-01-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-01-31	$2,086,848
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-01-31	$142,690
Net investment gain/loss from pooled separate accounts	2020-01-31	$30
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-01-31	No
Was there a failure to transmit to the plan any participant contributions	2020-01-31	No
Has the plan failed to provide any benefit when due under the plan	2020-01-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-01-31	$203,180
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	2020-01-31	No
Did the plan have assets held for investment	2020-01-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-01-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2020-01-31	Disclaimer
Accountancy firm name	2020-01-31	PLANTE & MORGAN, PLLC
Accountancy firm EIN	2020-01-31	388135795
2019 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED 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	$7,703,443
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$1,725,129
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$1,633,050
Expenses. Certain deemed distributions of participant loans	2019-12-31	$58,623
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$2,608,659
Value of total assets at end of year	2019-12-31	$36,557,221
Value of total assets at beginning of year	2019-12-31	$30,578,907
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$33,456
Total interest from all sources	2019-12-31	$350,958
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$783,472
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	$783,472
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$1,197,204
Participant contributions at end of year	2019-12-31	$847,546
Participant contributions at beginning of year	2019-12-31	$1,195,048
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$44,656
Assets. Other investments not covered elsewhere at end of year	2019-12-31	$4,857,017
Assets. Other investments not covered elsewhere at beginning of year	2019-12-31	$4,796,641
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$40,362
Administrative expenses (other) incurred	2019-12-31	$30,406
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	$5,978,314
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$36,557,221
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$30,578,907
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
Investment advisory and management fees	2019-12-31	$3,050
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$7,224,341
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$5,486,865
Interest on participant loans	2019-12-31	$42,561
Interest earned on other investments	2019-12-31	$308,397
Value of interest in common/collective trusts at end of year	2019-12-31	$19,506,059
Value of interest in common/collective trusts at beginning of year	2019-12-31	$14,590,857
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$4,122,258
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$4,413,328
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$3,960,354
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	$1,371,093
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$51,512
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,633,050
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	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	PLANTE & MORAN
Accountancy firm EIN	2019-12-31	381357951
Total income from all sources (including contributions)	2019-05-31	$42,839
Total of all expenses incurred	2019-05-31	$157,442
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-05-31	$148,477
Expenses. Certain deemed distributions of participant loans	2019-05-31	$1,922
Value of total assets at end of year	2019-05-31	$3,514,626
Value of total assets at beginning of year	2019-05-31	$3,629,229
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-05-31	$7,043
Total interest from all sources	2019-05-31	$73,575
Total dividends received (eg from common stock, registered investment company shares)	2019-05-31	$4,649
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-05-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-05-31	$4,649
Was this plan covered by a fidelity bond	2019-05-31	Yes
Value of fidelity bond cover	2019-05-31	$10,000,000
If this is an individual account plan, was there a blackout period	2019-05-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-05-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-05-31	No
Participant contributions at end of year	2019-05-31	$50,765
Participant contributions at beginning of year	2019-05-31	$41,750
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-05-31	$645
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-05-31	$502
Administrative expenses (other) incurred	2019-05-31	$7,043
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-05-31	No
Value of net income/loss	2019-05-31	$-114,603
Value of net assets at end of year (total assets less liabilities)	2019-05-31	$3,514,626
Value of net assets at beginning of year (total assets less liabilities)	2019-05-31	$3,629,229
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-05-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-05-31	No
Were any leases to which the plan was party in default or uncollectible	2019-05-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-05-31	$1,374,824
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-05-31	$1,480,048
Value of interest in pooled separate accounts at end of year	2019-05-31	$1,544
Value of interest in pooled separate accounts at beginning of year	2019-05-31	$1,500
Interest on participant loans	2019-05-31	$1,080
Interest earned on other investments	2019-05-31	$72,495
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-05-31	$2,086,848
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-05-31	$2,105,429
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-05-31	$-35,430
Net investment gain/loss from pooled separate accounts	2019-05-31	$45
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-05-31	No
Was there a failure to transmit to the plan any participant contributions	2019-05-31	No
Has the plan failed to provide any benefit when due under the plan	2019-05-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-05-31	$148,477
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-05-31	No
Did the plan have assets held for investment	2019-05-31	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	2019-05-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-05-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-05-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-05-31	Disclaimer
Accountancy firm name	2019-05-31	PLANTE & MORGAN, PLLC
Accountancy firm EIN	2019-05-31	388135795
2018 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED 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	$1,580,612
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$1,720,209
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,650,669
Expenses. Certain deemed distributions of participant loans	2018-12-31	$13,862
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$2,560,081
Value of total assets at end of year	2018-12-31	$30,578,907
Value of total assets at beginning of year	2018-12-31	$30,718,504
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$55,678
Total interest from all sources	2018-12-31	$391,961
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$717,611
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	$717,611
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	Yes
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	$1,148,558
Participant contributions at end of year	2018-12-31	$1,195,048
Participant contributions at beginning of year	2018-12-31	$1,213,187
Participant contributions at end of year	2018-12-31	$44,656
Participant contributions at beginning of year	2018-12-31	$38,240
Assets. Other investments not covered elsewhere at end of year	2018-12-31	$4,796,641
Assets. Other investments not covered elsewhere at beginning of year	2018-12-31	$5,225,450
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$31,657
Administrative expenses (other) incurred	2018-12-31	$52,635
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	$-139,597
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$30,578,907
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$30,718,504
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
Investment advisory and management fees	2018-12-31	$3,043
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$5,486,865
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$5,168,776
Interest on participant loans	2018-12-31	$53,563
Interest earned on other investments	2018-12-31	$338,398
Value of interest in common/collective trusts at end of year	2018-12-31	$14,590,857
Value of interest in common/collective trusts at beginning of year	2018-12-31	$14,442,542
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$4,413,328
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$4,582,240
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-2,089,041
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	$1,379,866
Employer contributions (assets) at end of year	2018-12-31	$51,512
Employer contributions (assets) at beginning of year	2018-12-31	$48,069
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$1,650,669
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	Yes
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	PLANTE & MORAN
Accountancy firm EIN	2018-12-31	381357951
Total income from all sources (including contributions)	2018-05-31	$301,941
Total of all expenses incurred	2018-05-31	$191,027
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-05-31	$178,549
Expenses. Certain deemed distributions of participant loans	2018-05-31	$4,988
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-05-31	$84,695
Value of total assets at end of year	2018-05-31	$3,629,229
Value of total assets at beginning of year	2018-05-31	$3,518,315
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-05-31	$7,490
Total interest from all sources	2018-05-31	$73,695
Total dividends received (eg from common stock, registered investment company shares)	2018-05-31	$7,258
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-05-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-05-31	$7,258
Was this plan covered by a fidelity bond	2018-05-31	Yes
Value of fidelity bond cover	2018-05-31	$10,000,000
If this is an individual account plan, was there a blackout period	2018-05-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-05-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-05-31	No
Participant contributions at end of year	2018-05-31	$41,750
Participant contributions at beginning of year	2018-05-31	$42,178
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-05-31	$502
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-05-31	$402
Administrative expenses (other) incurred	2018-05-31	$7,490
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-05-31	No
Value of net income/loss	2018-05-31	$110,914
Value of net assets at end of year (total assets less liabilities)	2018-05-31	$3,629,229
Value of net assets at beginning of year (total assets less liabilities)	2018-05-31	$3,518,315
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-05-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-05-31	No
Were any leases to which the plan was party in default or uncollectible	2018-05-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-05-31	$1,480,048
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-05-31	$1,340,949
Value of interest in pooled separate accounts at end of year	2018-05-31	$1,500
Value of interest in pooled separate accounts at beginning of year	2018-05-31	$1,393
Interest on participant loans	2018-05-31	$769
Interest earned on other investments	2018-05-31	$72,926
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-05-31	$2,105,429
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-05-31	$2,133,393
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-05-31	$136,250
Net investment gain/loss from pooled separate accounts	2018-05-31	$43
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-05-31	No
Was there a failure to transmit to the plan any participant contributions	2018-05-31	No
Has the plan failed to provide any benefit when due under the plan	2018-05-31	No
Contributions received in cash from employer	2018-05-31	$84,695
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-05-31	$178,549
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-05-31	No
Did the plan have assets held for investment	2018-05-31	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	2018-05-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-05-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-05-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-05-31	Disclaimer
Accountancy firm name	2018-05-31	PLANTE & MORGAN, PLLC
Accountancy firm EIN	2018-05-31	381357951
2017 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED 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	$5,165,836
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$2,886,698
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$2,873,530
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$2,265,920
Value of total assets at end of year	2017-12-31	$30,718,504
Value of total assets at beginning of year	2017-12-31	$28,439,366
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$13,168
Total interest from all sources	2017-12-31	$867,926
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$151,652
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	$151,652
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	Yes
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	$941,794
Participant contributions at end of year	2017-12-31	$1,213,187
Participant contributions at beginning of year	2017-12-31	$1,198,940
Participant contributions at end of year	2017-12-31	$38,240
Participant contributions at beginning of year	2017-12-31	$39,151
Assets. Other investments not covered elsewhere at end of year	2017-12-31	$5,225,450
Assets. Other investments not covered elsewhere at beginning of year	2017-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$3,732
Administrative expenses (other) incurred	2017-12-31	$7,328
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	$2,279,138
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$30,718,504
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$28,439,366
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
Investment advisory and management fees	2017-12-31	$5,840
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$5,168,776
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$12,715,568
Interest on participant loans	2017-12-31	$44,061
Interest earned on other investments	2017-12-31	$823,865
Value of interest in common/collective trusts at end of year	2017-12-31	$14,442,542
Value of interest in common/collective trusts at beginning of year	2017-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$4,582,240
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$14,428,700
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$1,817,910
Net investment gain or loss from common/collective trusts	2017-12-31	$62,428
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	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$1,320,394
Employer contributions (assets) at end of year	2017-12-31	$48,069
Employer contributions (assets) at beginning of year	2017-12-31	$57,007
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$2,873,530
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	Yes
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	PLANTE & MORAN
Accountancy firm EIN	2017-12-31	381357951
Total income from all sources (including contributions)	2017-05-31	$280,341
Total of all expenses incurred	2017-05-31	$1,071,258
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-05-31	$1,059,009
Expenses. Certain deemed distributions of participant loans	2017-05-31	$3,929
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-05-31	$-502
Value of total assets at end of year	2017-05-31	$3,518,315
Value of total assets at beginning of year	2017-05-31	$4,309,232
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-05-31	$8,320
Total interest from all sources	2017-05-31	$94,111
Total dividends received (eg from common stock, registered investment company shares)	2017-05-31	$4,756
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-05-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-05-31	$4,756
Was this plan covered by a fidelity bond	2017-05-31	Yes
Value of fidelity bond cover	2017-05-31	$10,000,000
If this is an individual account plan, was there a blackout period	2017-05-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-05-31	No
Participant contributions at end of year	2017-05-31	$42,178
Participant contributions at beginning of year	2017-05-31	$49,566
Participant contributions at beginning of year	2017-05-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2017-05-31	$-502
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-05-31	$402
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-05-31	$502
Administrative expenses (other) incurred	2017-05-31	$8,320
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-05-31	No
Value of net income/loss	2017-05-31	$-790,917
Value of net assets at end of year (total assets less liabilities)	2017-05-31	$3,518,315
Value of net assets at beginning of year (total assets less liabilities)	2017-05-31	$4,309,232
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-05-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-05-31	No
Were any leases to which the plan was party in default or uncollectible	2017-05-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-05-31	$1,340,949
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-05-31	$2,156,825
Value of interest in pooled separate accounts at end of year	2017-05-31	$1,393
Value of interest in pooled separate accounts at beginning of year	2017-05-31	$3,613
Interest on participant loans	2017-05-31	$987
Interest earned on other investments	2017-05-31	$93,124
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-05-31	$2,133,393
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-05-31	$2,098,726
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-05-31	$181,915
Net investment gain/loss from pooled separate accounts	2017-05-31	$61
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-05-31	No
Was there a failure to transmit to the plan any participant contributions	2017-05-31	No
Has the plan failed to provide any benefit when due under the plan	2017-05-31	No
Employer contributions (assets) at beginning of year	2017-05-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-05-31	$1,059,009
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-05-31	No
Did the plan have assets held for investment	2017-05-31	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	2017-05-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-05-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-05-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-05-31	Disclaimer
Accountancy firm name	2017-05-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2017-05-31	381357951
2016 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY 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	$3,472,167
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$1,620,409
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$1,578,332
Expenses. Certain deemed distributions of participant loans	2016-12-31	$38,177
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$1,961,046
Value of total assets at end of year	2016-12-31	$28,439,366
Value of total assets at beginning of year	2016-12-31	$26,587,608
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$3,900
Total interest from all sources	2016-12-31	$527,302
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$518,776
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	$518,776
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
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	$762,245
Participant contributions at end of year	2016-12-31	$1,198,940
Participant contributions at beginning of year	2016-12-31	$1,070,018
Participant contributions at end of year	2016-12-31	$39,151
Participant contributions at beginning of year	2016-12-31	$25,081
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$57,902
Other income not declared elsewhere	2016-12-31	$2,863
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$1,851,758
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$28,439,366
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$26,587,608
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$12,715,568
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$11,588,625
Interest on participant loans	2016-12-31	$36,286
Interest earned on other investments	2016-12-31	$491,016
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$14,428,700
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$13,866,063
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$462,180
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	Yes
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	$1,140,899
Employer contributions (assets) at end of year	2016-12-31	$57,007
Employer contributions (assets) at beginning of year	2016-12-31	$37,821
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$1,578,332
Contract administrator fees	2016-12-31	$3,900
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	PLANTE & MORAN
Accountancy firm EIN	2016-12-31	381357951
Total income from all sources (including contributions)	2016-05-31	$-12,106
Total of all expenses incurred	2016-05-31	$495,289
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-05-31	$485,785
Expenses. Certain deemed distributions of participant loans	2016-05-31	$812
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-05-31	$50,862
Value of total assets at end of year	2016-05-31	$4,309,232
Value of total assets at beginning of year	2016-05-31	$4,816,627
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-05-31	$8,692
Total interest from all sources	2016-05-31	$68,479
Total dividends received (eg from common stock, registered investment company shares)	2016-05-31	$5,890
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-05-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-05-31	$5,890
Was this plan covered by a fidelity bond	2016-05-31	Yes
Value of fidelity bond cover	2016-05-31	$10,000,000
If this is an individual account plan, was there a blackout period	2016-05-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-05-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-05-31	No
Contributions received from participants	2016-05-31	$49,730
Participant contributions at end of year	2016-05-31	$49,566
Participant contributions at beginning of year	2016-05-31	$71,339
Participant contributions at end of year	2016-05-31	$0
Participant contributions at beginning of year	2016-05-31	$6,330
Income. Received or receivable in cash from other sources (including rollovers)	2016-05-31	$1,132
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-05-31	$502
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-05-31	$722
Administrative expenses (other) incurred	2016-05-31	$8,692
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-05-31	No
Value of net income/loss	2016-05-31	$-507,395
Value of net assets at end of year (total assets less liabilities)	2016-05-31	$4,309,232
Value of net assets at beginning of year (total assets less liabilities)	2016-05-31	$4,816,627
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-05-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-05-31	No
Were any leases to which the plan was party in default or uncollectible	2016-05-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-05-31	$2,156,825
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-05-31	$2,438,040
Value of interest in pooled separate accounts at end of year	2016-05-31	$3,613
Value of interest in pooled separate accounts at beginning of year	2016-05-31	$4,603
Interest on participant loans	2016-05-31	$718
Interest earned on other investments	2016-05-31	$67,761
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-05-31	$2,098,726
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-05-31	$2,061,431
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-05-31	$-137,449
Net investment gain/loss from pooled separate accounts	2016-05-31	$112
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-05-31	No
Was there a failure to transmit to the plan any participant contributions	2016-05-31	No
Has the plan failed to provide any benefit when due under the plan	2016-05-31	No
Employer contributions (assets) at end of year	2016-05-31	$0
Employer contributions (assets) at beginning of year	2016-05-31	$234,162
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-05-31	$485,785
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-05-31	No
Did the plan have assets held for investment	2016-05-31	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	2016-05-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-05-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-05-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-05-31	Disclaimer
Accountancy firm name	2016-05-31	PLANTE & MORGAN, PLLC
Accountancy firm EIN	2016-05-31	381357951
2015 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY 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	$2,173,475
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$3,050,873
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$2,984,416
Expenses. Certain deemed distributions of participant loans	2015-12-31	$60,729
Value of total corrective distributions	2015-12-31	$585
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$1,720,960
Value of total assets at end of year	2015-12-31	$26,587,608
Value of total assets at beginning of year	2015-12-31	$27,465,006
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$5,143
Total interest from all sources	2015-12-31	$527,275
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$735,553
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	$735,553
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
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	$632,551
Participant contributions at end of year	2015-12-31	$1,070,018
Participant contributions at beginning of year	2015-12-31	$1,113,801
Participant contributions at end of year	2015-12-31	$25,081
Participant contributions at beginning of year	2015-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$92,761
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	$-877,398
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$26,587,608
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$27,465,006
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$11,588,625
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$11,860,928
Interest on participant loans	2015-12-31	$37,043
Interest earned on other investments	2015-12-31	$490,232
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$13,866,063
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$14,490,277
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-810,313
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$995,648
Employer contributions (assets) at end of year	2015-12-31	$37,821
Employer contributions (assets) at beginning of year	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$2,984,416
Contract administrator fees	2015-12-31	$5,143
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	PLANTE & MORAN
Accountancy firm EIN	2015-12-31	381357951
Total income from all sources (including contributions)	2015-05-31	$738,421
Total of all expenses incurred	2015-05-31	$556,287
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-05-31	$537,776
Expenses. Certain deemed distributions of participant loans	2015-05-31	$9,797
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-05-31	$526,455
Value of total assets at end of year	2015-05-31	$4,816,627
Value of total assets at beginning of year	2015-05-31	$4,634,493
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-05-31	$8,714
Total interest from all sources	2015-05-31	$79,711
Total dividends received (eg from common stock, registered investment company shares)	2015-05-31	$7,559
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-05-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-05-31	$7,559
Was this plan covered by a fidelity bond	2015-05-31	Yes
Value of fidelity bond cover	2015-05-31	$10,000,000
If this is an individual account plan, was there a blackout period	2015-05-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-05-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-05-31	No
Contributions received from participants	2015-05-31	$132,646
Participant contributions at end of year	2015-05-31	$71,339
Participant contributions at beginning of year	2015-05-31	$100,186
Participant contributions at end of year	2015-05-31	$6,330
Income. Received or receivable in cash from other sources (including rollovers)	2015-05-31	$915
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-05-31	$722
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-05-31	$919
Administrative expenses (other) incurred	2015-05-31	$8,714
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-05-31	No
Value of net income/loss	2015-05-31	$182,134
Value of net assets at end of year (total assets less liabilities)	2015-05-31	$4,816,627
Value of net assets at beginning of year (total assets less liabilities)	2015-05-31	$4,634,493
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-05-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-05-31	No
Were any leases to which the plan was party in default or uncollectible	2015-05-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-05-31	$2,438,040
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-05-31	$2,245,593
Value of interest in pooled separate accounts at end of year	2015-05-31	$4,603
Value of interest in pooled separate accounts at beginning of year	2015-05-31	$3,933
Interest on participant loans	2015-05-31	$1,094
Interest earned on other investments	2015-05-31	$78,617
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-05-31	$2,061,431
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-05-31	$2,283,862
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-05-31	$124,523
Net investment gain/loss from pooled separate accounts	2015-05-31	$173
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-05-31	No
Was there a failure to transmit to the plan any participant contributions	2015-05-31	No
Has the plan failed to provide any benefit when due under the plan	2015-05-31	No
Contributions received in cash from employer	2015-05-31	$392,894
Employer contributions (assets) at end of year	2015-05-31	$234,162
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-05-31	$537,776
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-05-31	No
Did the plan have assets held for investment	2015-05-31	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	2015-05-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-05-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-05-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-05-31	Disclaimer
Accountancy firm name	2015-05-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2015-05-31	381357951
2014 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY 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	$3,282,019
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$3,102,685
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$3,065,995
Expenses. Certain deemed distributions of participant loans	2014-12-31	$33,104
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,921,754
Value of total assets at end of year	2014-12-31	$27,465,006
Value of total assets at beginning of year	2014-12-31	$27,285,672
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$3,586
Total interest from all sources	2014-12-31	$536,165
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$813,796
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	$813,796
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
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	$676,750
Participant contributions at end of year	2014-12-31	$1,113,801
Participant contributions at beginning of year	2014-12-31	$919,309
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$323,900
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	$179,334
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$27,465,006
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$27,285,672
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$11,860,928
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$11,772,429
Interest on participant loans	2014-12-31	$34,654
Interest earned on other investments	2014-12-31	$501,511
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$14,490,277
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$14,593,934
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$10,304
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$921,104
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$3,065,995
Contract administrator fees	2014-12-31	$3,586
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	PLANTE & MORAN
Accountancy firm EIN	2014-12-31	381357951
2013 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$4,264,859
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$2,023,864
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,978,687
Expenses. Certain deemed distributions of participant loans	2013-12-31	$21,437
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$1,667,709
Value of total assets at end of year	2013-12-31	$27,285,672
Value of total assets at beginning of year	2013-12-31	$25,044,677
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$23,740
Total interest from all sources	2013-12-31	$529,984
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$572,362
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	$572,362
Administrative expenses professional fees incurred	2013-12-31	$19,950
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
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	$694,898
Participant contributions at end of year	2013-12-31	$919,309
Participant contributions at beginning of year	2013-12-31	$772,435
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$753,433
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	2013-12-31	$2
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	$2,240,995
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$27,285,672
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$25,044,677
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$11,772,429
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$9,746,841
Interest on participant loans	2013-12-31	$26,677
Interest earned on other investments	2013-12-31	$503,305
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$2,852
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$2,852
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$2
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$14,593,934
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$14,482,020
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$1,494,804
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$219,378
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$40,527
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,978,687
Contract administrator fees	2013-12-31	$3,790
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	PLANTE & MORAN
Accountancy firm EIN	2013-12-31	381357951
2012 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$27,500
Total income from all sources (including contributions)	2012-12-31	$3,857,338
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$1,741,416
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$1,738,203
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$2,086,731
Value of total assets at end of year	2012-12-31	$25,044,677
Value of total assets at beginning of year	2012-12-31	$22,956,255
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$3,213
Total interest from all sources	2012-12-31	$513,286
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$222,648
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$222,648
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$613,148
Participant contributions at end of year	2012-12-31	$772,435
Participant contributions at beginning of year	2012-12-31	$796,580
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$423,171
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$27,500
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$27,500
Total non interest bearing cash at end of year	2012-12-31	$2
Total non interest bearing cash at beginning of year	2012-12-31	$2
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$2,115,922
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$25,044,677
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$22,928,755
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$9,746,841
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$8,591,376
Interest on participant loans	2012-12-31	$26,135
Interest earned on other investments	2012-12-31	$487,147
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$2,852
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$59,207
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$59,207
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$4
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$14,482,020
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$13,481,590
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$1,034,673
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$1,050,412
Employer contributions (assets) at end of year	2012-12-31	$40,527
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$1,738,203
Contract administrator fees	2012-12-31	$3,213
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	PLANTE & MORAN
Accountancy firm EIN	2012-12-31	381357951
2011 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$27,500
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$24,955
Total income from all sources (including contributions)	2011-12-31	$2,338,531
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$1,377,119
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,357,615
Expenses. Certain deemed distributions of participant loans	2011-12-31	$16,715
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$1,933,515
Value of total assets at end of year	2011-12-31	$22,956,255
Value of total assets at beginning of year	2011-12-31	$21,992,298
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$2,789
Total interest from all sources	2011-12-31	$479,347
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$239,891
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$239,891
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$686,799
Participant contributions at end of year	2011-12-31	$796,580
Participant contributions at beginning of year	2011-12-31	$800,009
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$51,622
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$27,500
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$24,955
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$27,500
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$24,955
Total non interest bearing cash at end of year	2011-12-31	$2
Total non interest bearing cash at beginning of year	2011-12-31	$2
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$961,412
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$22,928,755
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$21,967,343
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$8,591,376
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$8,589,400
Interest on participant loans	2011-12-31	$24,983
Interest earned on other investments	2011-12-31	$454,362
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$59,207
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$2,797
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$2,797
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$2
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$13,481,590
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$12,575,135
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-314,222
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$1,195,094
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,357,615
Contract administrator fees	2011-12-31	$2,789
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	PLANTE & MORAN
Accountancy firm EIN	2011-12-31	381357951
2010 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$24,955
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$55,275
Total income from all sources (including contributions)	2010-12-31	$3,442,666
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$1,106,221
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,086,150
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$1,856,514
Value of total assets at end of year	2010-12-31	$21,992,298
Value of total assets at beginning of year	2010-12-31	$19,686,173
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$20,071
Total interest from all sources	2010-12-31	$472,287
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$232,368
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$232,368
Administrative expenses professional fees incurred	2010-12-31	$17,535
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$602,803
Participant contributions at end of year	2010-12-31	$800,009
Participant contributions at beginning of year	2010-12-31	$608,365
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$53,511
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$24,955
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$27,080
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$24,955
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$55,275
Other income not declared elsewhere	2010-12-31	$17,535
Total non interest bearing cash at end of year	2010-12-31	$2
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$2,336,445
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$21,967,343
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$19,630,898
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$8,589,400
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$7,574,295
Interest on participant loans	2010-12-31	$22,103
Interest earned on other investments	2010-12-31	$450,181
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$2,797
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$31,067
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$31,067
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$3
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$12,575,135
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$11,445,366
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$863,962
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$1,200,200
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,086,150
Contract administrator fees	2010-12-31	$2,536
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	ARNETT & FOSTER
Accountancy firm EIN	2010-12-31	550486667
2009 : O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN

2022: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY 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: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY 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: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED 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: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2019 form 5500 responses
2019-06-01	Type of plan entity	Single employer plan
2019-06-01	Submission has been amended	Yes
2019-06-01	This submission is the final filing	Yes
2019-06-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-06-01	Plan funding arrangement – Insurance	Yes
2019-06-01	Plan funding arrangement – Trust	Yes
2019-06-01	Plan benefit arrangement – Insurance	Yes
2019-06-01	Plan benefit arrangement - Trust	Yes
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: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2018 form 5500 responses
2018-06-01	Type of plan entity	Single employer plan
2018-06-01	Plan funding arrangement – Insurance	Yes
2018-06-01	Plan funding arrangement – Trust	Yes
2018-06-01	Plan benefit arrangement – Insurance	Yes
2018-06-01	Plan benefit arrangement - Trust	Yes
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: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2017 form 5500 responses
2017-06-01	Type of plan entity	Single employer plan
2017-06-01	Plan funding arrangement – Insurance	Yes
2017-06-01	Plan funding arrangement – Trust	Yes
2017-06-01	Plan benefit arrangement – Insurance	Yes
2017-06-01	Plan benefit arrangement - Trust	Yes
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: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2016 form 5500 responses
2016-06-01	Type of plan entity	Single employer plan
2016-06-01	Plan funding arrangement – Insurance	Yes
2016-06-01	Plan funding arrangement – Trust	Yes
2016-06-01	Plan benefit arrangement – Insurance	Yes
2016-06-01	Plan benefit arrangement - Trust	Yes
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 – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2015 form 5500 responses
2015-06-01	Type of plan entity	Single employer plan
2015-06-01	Plan funding arrangement – Insurance	Yes
2015-06-01	Plan funding arrangement – Trust	Yes
2015-06-01	Plan benefit arrangement – Insurance	Yes
2015-06-01	Plan benefit arrangement - Trust	Yes
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Plan funding arrangement – Insurance	Yes
2014-06-01	Plan funding arrangement – Trust	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2014-06-01	Plan benefit arrangement - Trust	Yes
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: O'BLENESS MEMORIAL HOSPITAL TAX SHELTERED ANNUITY PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	896255 007
Policy instance	2
Insurance contract or identification number 896255 007 Number of Individuals Covered 1 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? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	192511
Policy instance	1
Insurance contract or identification number 192511 Number of Individuals Covered 84 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 Insurance broker organization code? 4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	192511
Policy instance	1
Insurance contract or identification number 192511 Number of Individuals Covered 87 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 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 Insurance broker organization code? 4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	896255 007
Policy instance	2
Insurance contract or identification number 896255 007 Number of Individuals Covered 1 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 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? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	192511
Policy instance	1
Insurance contract or identification number 192511 Number of Individuals Covered 88 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 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 Insurance broker organization code? 4
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract number	FA053255
Policy instance	1
Insurance contract or identification number FA053255 Number of Individuals Covered 0 Insurance policy start date 2019-06-01 Insurance policy end date 2020-01-31 Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	192511
Policy instance	1
Insurance contract or identification number 192511 Number of Individuals Covered 93 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 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 Insurance broker organization code? 4
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract number	FA053255
Policy instance	1
Insurance contract or identification number FA053255 Number of Individuals Covered 193 Insurance policy start date 2018-06-01 Insurance policy end date 2019-05-31 Total amount of commissions paid to insurance broker USD $6,968 Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,968 Insurance broker organization code? 3
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract number	FA053255
Policy instance	1
Insurance contract or identification number FA053255 Number of Individuals Covered 205 Insurance policy start date 2017-06-01 Insurance policy end date 2018-05-31 Total amount of commissions paid to insurance broker USD $4,655 Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	192511
Policy instance	1
Insurance contract or identification number 192511 Number of Individuals Covered 108 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $1,459 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 $749 Insurance broker organization code? 4 Insurance broker name CETERA ADVISORS LLC
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract number	FA053255
Policy instance	1
Insurance contract or identification number FA053255 Number of Individuals Covered 238 Insurance policy start date 2015-06-01 Insurance policy end date 2016-05-31 Total amount of commissions paid to insurance broker USD $4,330 Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,330 Insurance broker organization code? 3 Insurance broker name NFP SECURITIES, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	893037-007
Policy instance	1
Insurance contract or identification number 893037-007 Number of Individuals Covered 515 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $10,862 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,974 Insurance broker organization code? 4 Insurance broker name MFSC INSURANCE AGCY OF OH INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	192511
Policy instance	2
Insurance contract or identification number 192511 Number of Individuals Covered 116 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $6,772 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,729 Insurance broker organization code? 4 Insurance broker name CETERA ADVISORS LLC
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract number	FA053255
Policy instance	1
Insurance contract or identification number FA053255 Number of Individuals Covered 173 Insurance policy start date 2014-06-01 Insurance policy end date 2015-05-31 Total amount of commissions paid to insurance broker USD $4,977 Are there contracts with unallocated funds for contracts of type guaranteed investment? Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,977 Insurance broker organization code? 3 Insurance broker name NFP SECURITIES, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	192511
Policy instance	2
Insurance contract or identification number 192511 Number of Individuals Covered 117 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $6,911 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,804 Insurance broker organization code? 4 Insurance broker name CETERA ADVISORS LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	893037-007
Policy instance	1
Insurance contract or identification number 893037-007 Number of Individuals Covered 487 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $11,331 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,232 Insurance broker organization code? 4 Insurance broker name MFSC INSURANCE AGCY OF OH INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	192511
Policy instance	2
Insurance contract or identification number 192511 Number of Individuals Covered 129 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $6,614 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,638 Insurance broker organization code? 4 Insurance broker name CETERA ADVISORS LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	893037-007
Policy instance	1
Insurance contract or identification number 893037-007 Number of Individuals Covered 514 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $11,205 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,163 Insurance broker organization code? 4 Insurance broker name MFSC INSURANCE AGCY OF OH INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	893037-007
Policy instance	1
Insurance contract or identification number 893037-007 Number of Individuals Covered 469 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $10,536 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,795 Insurance broker organization code? 4 Insurance broker name MFSC INSURANCE AGCY OF OH INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	192511
Policy instance	2
Insurance contract or identification number 192511 Number of Individuals Covered 135 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $6,854 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,782 Insurance broker organization code? 4 Insurance broker name CETERA ADVISORS LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	893037-007
Policy instance	2
Insurance contract or identification number 893037-007 Number of Individuals Covered 476 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $10,024 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	192511
Policy instance	1
Insurance contract or identification number 192511 Number of Individuals Covered 146 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $6,745 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	893037-007
Policy instance	2
Insurance contract or identification number 893037-007 Number of Individuals Covered 474 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $8,690 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	192511
Policy instance	1
Insurance contract or identification number 192511 Number of Individuals Covered 157 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $6,481 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No