401k Plan data: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN plan

AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 401k Plan overview

Plan Name	AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN
Plan identification number	002

AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.

401k Sponsoring company profile

NORTH CANTON MEDICAL FOUNDATION has sponsored the creation of one or more 401k plans.

Company Name: NORTH CANTON MEDICAL FOUNDATION

Employer identification number (EIN): 341088530

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2015-01-01 AMY BUDD
002 2015-01-01 SUSAN OLIVERA
002 2014-01-01 BOB NAPPI
002 2013-01-01 BOB NAPPI
002 2012-01-01 BOB NAPPI
002 2011-01-01 BOB NAPPI
002 2009-01-01 BOB NAPPI
002 2009-01-01 BOB NAPPI

Plan id#	Filing Submission Date	Name of Administrator
002	2015-01-01	AMY BUDD
002	2015-01-01	SUSAN OLIVERA
002	2014-01-01	BOB NAPPI
002	2013-01-01	BOB NAPPI
002	2012-01-01	BOB NAPPI
002	2011-01-01	BOB NAPPI
002	2009-01-01	BOB NAPPI
002	2009-01-01	BOB NAPPI

Plan Statistics for AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN

401k plan membership statisitcs for AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN

Measure Date Value
2015: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 200
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
2014: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 212
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 127
Number of retired or separated participants receiving benefits 2014-01-01 8
Number of other retired or separated participants entitled to future benefits 2014-01-01 65
Total of all active and inactive participants 2014-01-01 200
Total participants 2014-01-01 200
Number of participants with account balances 2014-01-01 195
2013: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 213
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 127
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 77
Total of all active and inactive participants 2013-01-01 212
Total participants 2013-01-01 212
Number of participants with account balances 2013-01-01 206
2012: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 235
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 136
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 72
Total of all active and inactive participants 2012-01-01 213
Total participants 2012-01-01 213
Number of participants with account balances 2012-01-01 202
2011: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 253
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 143
Number of retired or separated participants receiving benefits 2011-01-01 4
Number of other retired or separated participants entitled to future benefits 2011-01-01 87
Total of all active and inactive participants 2011-01-01 234
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 235
Number of participants with account balances 2011-01-01 227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 6
2009: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 311
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 173
Number of retired or separated participants receiving benefits 2009-01-01 4
Number of other retired or separated participants entitled to future benefits 2009-01-01 105
Total of all active and inactive participants 2009-01-01 282
Total participants 2009-01-01 282
Number of participants with account balances 2009-01-01 277
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 8

Measure	Date	Value
2015: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	200
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
2014: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	212
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	127
Number of retired or separated participants receiving benefits	2014-01-01	8
Number of other retired or separated participants entitled to future benefits	2014-01-01	65
Total of all active and inactive participants	2014-01-01	200
Total participants	2014-01-01	200
Number of participants with account balances	2014-01-01	195
2013: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	213
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	127
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	77
Total of all active and inactive participants	2013-01-01	212
Total participants	2013-01-01	212
Number of participants with account balances	2013-01-01	206
2012: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	235
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	136
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	72
Total of all active and inactive participants	2012-01-01	213
Total participants	2012-01-01	213
Number of participants with account balances	2012-01-01	202
2011: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	253
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	143
Number of retired or separated participants receiving benefits	2011-01-01	4
Number of other retired or separated participants entitled to future benefits	2011-01-01	87
Total of all active and inactive participants	2011-01-01	234
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	235
Number of participants with account balances	2011-01-01	227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	6
2009: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	311
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	173
Number of retired or separated participants receiving benefits	2009-01-01	4
Number of other retired or separated participants entitled to future benefits	2009-01-01	105
Total of all active and inactive participants	2009-01-01	282
Total participants	2009-01-01	282
Number of participants with account balances	2009-01-01	277
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	8

Financial Data on AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN

Measure	Date	Value
2015 : AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets	2015-12-31	$36,320
Total unrealized appreciation/depreciation of assets	2015-12-31	$36,320
Total transfer of assets from this plan	2015-12-31	$28,162,809
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	$-302,178
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$2,143,114
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$2,143,114
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$0
Value of total assets at end of year	2015-12-31	$0
Value of total assets at beginning of year	2015-12-31	$30,608,101
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$0
Total interest from all sources	2015-12-31	$5,293
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$1,023
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$1,023
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
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
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$118,121
Assets. Other investments not covered elsewhere at end of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2015-12-31	$1,142,075
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-2,445,292
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$30,608,101
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$19,479,122
Value of interest in common/collective trusts at end of year	2015-12-31	$0
Value of interest in common/collective trusts at beginning of year	2015-12-31	$9,868,783
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$5,293
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-50,893
Net investment gain or loss from common/collective trusts	2015-12-31	$-293,921
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	Yes
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$2,143,114
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	No
Did the plan have assets held for investment	2015-12-31	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	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	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2015-12-31	410746749
Unrealized appreciation/depreciation of real estate assets	2015-12-02	$36,320
Total unrealized appreciation/depreciation of assets	2015-12-02	$36,320
Total transfer of assets from this plan	2015-12-02	$28,162,809
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-02	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-02	$0
Total income from all sources (including contributions)	2015-12-02	$-302,178
Total loss/gain on sale of assets	2015-12-02	$0
Total of all expenses incurred	2015-12-02	$2,143,114
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-02	$2,143,114
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-02	$0
Value of total assets at end of year	2015-12-02	$0
Value of total assets at beginning of year	2015-12-02	$30,608,101
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-02	$0
Total interest from all sources	2015-12-02	$5,293
Total dividends received (eg from common stock, registered investment company shares)	2015-12-02	$1,023
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-02	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-02	$1,023
Was this plan covered by a fidelity bond	2015-12-02	Yes
Value of fidelity bond cover	2015-12-02	$500,000
If this is an individual account plan, was there a blackout period	2015-12-02	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-02	No
Participant contributions at end of year	2015-12-02	$0
Participant contributions at beginning of year	2015-12-02	$118,121
Assets. Other investments not covered elsewhere at end of year	2015-12-02	$0
Assets. Other investments not covered elsewhere at beginning of year	2015-12-02	$1,142,075
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-02	No
Value of net income/loss	2015-12-02	$-2,445,292
Value of net assets at end of year (total assets less liabilities)	2015-12-02	$0
Value of net assets at beginning of year (total assets less liabilities)	2015-12-02	$30,608,101
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-02	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-02	No
Were any leases to which the plan was party in default or uncollectible	2015-12-02	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-02	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-02	$19,479,122
Value of interest in common/collective trusts at end of year	2015-12-02	$0
Value of interest in common/collective trusts at beginning of year	2015-12-02	$9,868,783
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-02	$5,293
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-02	$-50,893
Net investment gain or loss from common/collective trusts	2015-12-02	$-293,921
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-02	Yes
Was there a failure to transmit to the plan any participant contributions	2015-12-02	No
Has the plan failed to provide any benefit when due under the plan	2015-12-02	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-02	$2,143,114
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-02	No
Did the plan have assets held for investment	2015-12-02	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	2015-12-02	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-02	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-02	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-02	Disclaimer
Accountancy firm name	2015-12-02	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2015-12-02	410746749
2014 : AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$63,263
Total unrealized appreciation/depreciation of assets	2014-12-31	$63,263
Total income from all sources (including contributions)	2014-12-31	$2,754,299
Total of all expenses incurred	2014-12-31	$2,761,622
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$2,757,316
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$472,717
Value of total assets at end of year	2014-12-31	$30,608,101
Value of total assets at beginning of year	2014-12-31	$30,615,424
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$4,306
Total interest from all sources	2014-12-31	$177,989
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$737,409
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	$737,409
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$187,662
Participant contributions at end of year	2014-12-31	$118,121
Participant contributions at beginning of year	2014-12-31	$107,478
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$1,142,075
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$1,256,955
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$181,917
Administrative expenses (other) incurred	2014-12-31	$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	2014-12-31	No
Value of net income/loss	2014-12-31	$-7,323
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$30,608,101
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$30,615,424
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	$19,479,122
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$19,111,272
Interest on participant loans	2014-12-31	$4,087
Value of interest in common/collective trusts at end of year	2014-12-31	$9,868,783
Value of interest in common/collective trusts at beginning of year	2014-12-31	$10,139,719
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$173,902
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$29,279
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$1,283,912
Net investment gain or loss from common/collective trusts	2014-12-31	$19,009
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	$103,138
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$2,728,037
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-12-31	No
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	BRUNER-COX LLP
Accountancy firm EIN	2014-12-31	340641962
2013 : AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2013-12-31	$68,142
Total unrealized appreciation/depreciation of assets	2013-12-31	$68,142
Total income from all sources (including contributions)	2013-12-31	$5,214,647
Total of all expenses incurred	2013-12-31	$1,531,602
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,516,629
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$863,857
Value of total assets at end of year	2013-12-31	$30,615,424
Value of total assets at beginning of year	2013-12-31	$26,932,379
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$14,973
Total interest from all sources	2013-12-31	$182,330
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$537,985
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	$537,985
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$556,761
Participant contributions at end of year	2013-12-31	$107,478
Participant contributions at beginning of year	2013-12-31	$122,966
Assets. Other investments not covered elsewhere at end of year	2013-12-31	$1,256,955
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$1,195,370
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$30,923
Administrative expenses (other) incurred	2013-12-31	$14,973
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	$3,683,045
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$30,615,424
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$26,932,379
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	$19,111,272
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$15,410,040
Interest on participant loans	2013-12-31	$4,740
Value of interest in common/collective trusts at end of year	2013-12-31	$10,139,719
Value of interest in common/collective trusts at beginning of year	2013-12-31	$10,204,003
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$177,590
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$30,852
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$3,287,421
Net investment gain or loss from common/collective trusts	2013-12-31	$274,912
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	$276,173
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,485,777
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
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	BRUNER-COX LLP
Accountancy firm EIN	2013-12-31	340641962
2012 : AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$55,923
Total unrealized appreciation/depreciation of assets	2012-12-31	$55,923
Total income from all sources (including contributions)	2012-12-31	$2,931,923
Total of all expenses incurred	2012-12-31	$3,383,115
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$3,356,511
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$559,662
Value of total assets at end of year	2012-12-31	$26,932,379
Value of total assets at beginning of year	2012-12-31	$27,383,571
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$26,604
Total interest from all sources	2012-12-31	$5,398
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2012-12-31	0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	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	$559,662
Participant contributions at end of year	2012-12-31	$122,966
Participant contributions at beginning of year	2012-12-31	$98,083
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$1,195,370
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$1,139,447
Other income not declared elsewhere	2012-12-31	$3,872
Administrative expenses (other) incurred	2012-12-31	$26,604
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	$-451,192
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$26,932,379
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$27,383,571
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$15,410,040
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$14,844,890
Interest on participant loans	2012-12-31	$5,398
Value of interest in common/collective trusts at end of year	2012-12-31	$10,204,003
Value of interest in common/collective trusts at beginning of year	2012-12-31	$11,301,151
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$31,255
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$2,044,374
Net investment gain or loss from common/collective trusts	2012-12-31	$262,694
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	Yes
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$3,325,256
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	HALL KISTLER & COMPANY LLP
Accountancy firm EIN	2012-12-31	340715770
2011 : AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$64,649
Total unrealized appreciation/depreciation of assets	2011-12-31	$64,649
Total income from all sources (including contributions)	2011-12-31	$793,026
Total of all expenses incurred	2011-12-31	$1,069,228
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,047,330
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$573,367
Value of total assets at end of year	2011-12-31	$27,383,571
Value of total assets at beginning of year	2011-12-31	$27,659,773
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$21,898
Total interest from all sources	2011-12-31	$4,294
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	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	$573,367
Participant contributions at end of year	2011-12-31	$98,083
Participant contributions at beginning of year	2011-12-31	$85,464
Assets. Other investments not covered elsewhere at end of year	2011-12-31	$1,139,447
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$1,074,798
Other income not declared elsewhere	2011-12-31	$23,224
Administrative expenses (other) incurred	2011-12-31	$21,898
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	$-276,202
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$27,383,571
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$27,659,773
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$14,844,890
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$16,174,077
Interest on participant loans	2011-12-31	$4,294
Value of interest in common/collective trusts at end of year	2011-12-31	$11,301,151
Value of interest in common/collective trusts at beginning of year	2011-12-31	$10,325,434
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$31,255
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-191,055
Net investment gain or loss from common/collective trusts	2011-12-31	$318,547
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,016,075
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	HALL KISTLER & COMPANY LLP
Accountancy firm EIN	2011-12-31	340715770
2010 : AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$44,193
Total unrealized appreciation/depreciation of assets	2010-12-31	$44,193
Total income from all sources (including contributions)	2010-12-31	$2,730,076
Total of all expenses incurred	2010-12-31	$1,529,787
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,502,090
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$562,578
Value of total assets at end of year	2010-12-31	$27,659,773
Value of total assets at beginning of year	2010-12-31	$26,459,484
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$27,697
Total interest from all sources	2010-12-31	$6,909
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$1,000,000
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$562,578
Participant contributions at end of year	2010-12-31	$85,464
Participant contributions at beginning of year	2010-12-31	$132,271
Participant contributions at end of year	2010-12-31	$0
Participant contributions at beginning of year	2010-12-31	$42,527
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$1,074,798
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$1,030,605
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$1,625
Other income not declared elsewhere	2010-12-31	$13,502
Administrative expenses (other) incurred	2010-12-31	$27,697
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	$1,200,289
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$27,659,773
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$26,459,484
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	$16,174,077
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$14,755,843
Interest on participant loans	2010-12-31	$6,909
Value of interest in common/collective trusts at end of year	2010-12-31	$10,325,434
Value of interest in common/collective trusts at beginning of year	2010-12-31	$10,403,148
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$30,882
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$1,804,841
Net investment gain or loss from common/collective trusts	2010-12-31	$298,053
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
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
Employer contributions (assets) at end of year	2010-12-31	$0
Employer contributions (assets) at beginning of year	2010-12-31	$93,465
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,471,208
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	HALL KISTLER & COMPANY LLP
Accountancy firm EIN	2010-12-31	340715770

Form 5500 Responses for AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN

2015: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
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: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
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: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
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: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
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: AULTMAN NORTH CANTON MEDICAL GROUP RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	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

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0001773884

Policy instance

Insurance contract or identification number	0001773884
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Are there contracts with allocated funds for individual policies?	Yes
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
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

320050

Policy instance

Insurance contract or identification number	320050
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Are there contracts with allocated funds for individual policies?	Yes
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
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

000E028935

Policy instance

Insurance contract or identification number	000E028935
Number of Individuals Covered	1
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0001773884

Policy instance

Insurance contract or identification number	0001773884
Number of Individuals Covered	1
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0001594075

Policy instance

Insurance contract or identification number	0001594075
Number of Individuals Covered	1
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

320050

Policy instance

Insurance contract or identification number	320050
Number of Individuals Covered	11
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $325
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $325
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

320050

Policy instance

Insurance contract or identification number	320050
Number of Individuals Covered	13
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $328
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $328
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

000E028935

Policy instance

Insurance contract or identification number	000E028935
Number of Individuals Covered	1
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0001594075

Policy instance

Insurance contract or identification number	0001594075
Number of Individuals Covered	1
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0001773884

Policy instance

Insurance contract or identification number	0001773884
Number of Individuals Covered	1
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0001773884

Policy instance

Insurance contract or identification number	0001773884
Number of Individuals Covered	1
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	SIRAK FINANCIAL

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

320050

Policy instance

Insurance contract or identification number	320050
Number of Individuals Covered	13
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $332
Are there contracts with allocated funds for individual policies?	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 $332
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0001594075

Policy instance

Insurance contract or identification number	0001594075
Number of Individuals Covered	1
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

000E028935

Policy instance

Insurance contract or identification number	000E028935
Number of Individuals Covered	1
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

000E028935

Policy instance

Insurance contract or identification number	000E028935
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0001594075

Policy instance

Insurance contract or identification number	0001594075
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

320050

Policy instance

Insurance contract or identification number	320050
Number of Individuals Covered	13
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $332
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0001773884

Policy instance

Insurance contract or identification number	0001773884
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

000E028935

Policy instance

Insurance contract or identification number	000E028935
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0001594075

Policy instance

Insurance contract or identification number	0001594075
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

320050

Policy instance

Insurance contract or identification number	320050
Number of Individuals Covered	15
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $434
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $434
Insurance broker organization code?	3
Insurance broker name	SIRAK FINANCIAL

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Company Name:	NORTH CANTON MEDICAL FOUNDATION
Employer identification number (EIN):	341088530
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)