401k Plan data: MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN plan

MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN
Plan identification number	003

MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

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

Company Name: PROMEDICA

Employer identification number (EIN): 381984289

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2015-01-01 KAREN STRAUSS KAREN STRAUSS 2016-10-17
003 2015-01-01 KAREN STRAUSS KAREN STRAUSS 2017-10-16
003 2014-01-01 THOMAS W. SCHILLING
003 2013-01-01 THOMAS W. SCHILLING
003 2012-01-01 THOMAS W. SCHILLING
003 2011-01-01 THOMAS W. SCHILLING THOMAS W. SCHILLING 2012-10-13
003 2009-01-01 THOMAS W. SCHILLING THOMAS W. SCHILLING 2011-01-31
003 2009-01-01 THOMAS W. SCHILLING THOMAS W. SCHILLING 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
003	2015-01-01	KAREN STRAUSS	KAREN STRAUSS	2016-10-17
003	2015-01-01	KAREN STRAUSS	KAREN STRAUSS	2017-10-16
003	2014-01-01	THOMAS W. SCHILLING
003	2013-01-01	THOMAS W. SCHILLING
003	2012-01-01	THOMAS W. SCHILLING
003	2011-01-01	THOMAS W. SCHILLING	THOMAS W. SCHILLING	2012-10-13
003	2009-01-01	THOMAS W. SCHILLING	THOMAS W. SCHILLING	2011-01-31
003	2009-01-01	THOMAS W. SCHILLING	THOMAS W. SCHILLING	2010-10-14

Plan Statistics for MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN

Measure Date Value
2015: MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,867
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,935
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,420
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 447
Total of all active and inactive participants 2014-01-01 1,867
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 1,867
Number of participants with account balances 2014-01-01 1,859
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 213
2013: MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 2,168
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,478
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 457
Total of all active and inactive participants 2013-01-01 1,935
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 1,935
Number of participants with account balances 2013-01-01 1,837
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 235
2012: MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 2,042
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,744
Number of retired or separated participants receiving benefits 2012-01-01 23
Number of other retired or separated participants entitled to future benefits 2012-01-01 401
Total of all active and inactive participants 2012-01-01 2,168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 2,168
Number of participants with account balances 2012-01-01 1,755
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 212
2011: MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,842
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,749
Number of retired or separated participants receiving benefits 2011-01-01 42
Number of other retired or separated participants entitled to future benefits 2011-01-01 251
Total of all active and inactive participants 2011-01-01 2,042
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 2,042
Number of participants with account balances 2011-01-01 1,544
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 179
2009: MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,089
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,141
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 184
Total of all active and inactive participants 2009-01-01 1,325
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 1,325
Number of participants with account balances 2009-01-01 1,057
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 9

Measure	Date	Value
2015: MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,867
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,935
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,420
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	447
Total of all active and inactive participants	2014-01-01	1,867
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	1,867
Number of participants with account balances	2014-01-01	1,859
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	213
2013: MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	2,168
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,478
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	457
Total of all active and inactive participants	2013-01-01	1,935
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	1,935
Number of participants with account balances	2013-01-01	1,837
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	235
2012: MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	2,042
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,744
Number of retired or separated participants receiving benefits	2012-01-01	23
Number of other retired or separated participants entitled to future benefits	2012-01-01	401
Total of all active and inactive participants	2012-01-01	2,168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	2,168
Number of participants with account balances	2012-01-01	1,755
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	212
2011: MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,842
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,749
Number of retired or separated participants receiving benefits	2011-01-01	42
Number of other retired or separated participants entitled to future benefits	2011-01-01	251
Total of all active and inactive participants	2011-01-01	2,042
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	2,042
Number of participants with account balances	2011-01-01	1,544
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	179
2009: MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,089
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,141
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	184
Total of all active and inactive participants	2009-01-01	1,325
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	1,325
Number of participants with account balances	2009-01-01	1,057
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	9

Financial Data on MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN

Measure	Date	Value
2015 : MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets from this plan	2015-12-31	$60,934,097
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	$79,143
Total income from all sources (including contributions)	2015-12-31	$-3,816,947
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$10,793,895
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$10,538,372
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$5,212,965
Value of total assets at end of year	2015-12-31	$0
Value of total assets at beginning of year	2015-12-31	$75,624,082
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$255,523
Total interest from all sources	2015-12-31	$249,565
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$3,958,245
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2015-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$3,958,245
Administrative expenses professional fees incurred	2015-12-31	$15,500
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$4,283,390
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$1,436,608
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$120,914
Other income not declared elsewhere	2015-12-31	$264,173
Liabilities. Value of operating payables at end of year	2015-12-31	$0
Liabilities. Value of operating payables at beginning of year	2015-12-31	$79,143
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	$-14,610,842
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	$75,544,939
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	$63,704,779
Interest on participant loans	2015-12-31	$49,061
Interest earned on other investments	2015-12-31	$200,504
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$8,906,759
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-13,488,835
Net investment gain/loss from pooled separate accounts	2015-12-31	$-13,060
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$808,661
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$1,575,936
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$10,538,372
Contract administrator fees	2015-12-31	$240,023
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	Yes
Did the plan have assets held for investment	2015-12-31	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	Yes
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, PLLC
Accountancy firm EIN	2015-12-31	381357951
2014 : MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS 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	$79,143
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$38,648
Total income from all sources (including contributions)	2014-12-31	$9,888,989
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$10,165,855
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$10,008,772
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$5,606,674
Value of total assets at end of year	2014-12-31	$75,624,082
Value of total assets at beginning of year	2014-12-31	$75,860,453
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$157,083
Total interest from all sources	2014-12-31	$243,330
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$3,078,026
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	$3,078,026
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	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	$3,744,322
Participant contributions at end of year	2014-12-31	$1,436,608
Participant contributions at beginning of year	2014-12-31	$1,340,368
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$59,526
Other income not declared elsewhere	2014-12-31	$177,787
Administrative expenses (other) incurred	2014-12-31	$157,083
Liabilities. Value of operating payables at end of year	2014-12-31	$79,143
Liabilities. Value of operating payables at beginning of year	2014-12-31	$38,648
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	$-276,866
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$75,544,939
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$75,821,805
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	$63,704,779
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$62,881,609
Interest on participant loans	2014-12-31	$48,730
Interest earned on other investments	2014-12-31	$194,600
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$8,906,759
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$10,044,565
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$728,440
Net investment gain/loss from pooled separate accounts	2014-12-31	$54,732
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	Yes
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	$1,802,826
Employer contributions (assets) at end of year	2014-12-31	$1,575,936
Employer contributions (assets) at beginning of year	2014-12-31	$1,593,911
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$10,008,772
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, PLLC
Accountancy firm EIN	2014-12-31	381357951
2013 : MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS 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	$38,648
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$100,694
Total income from all sources (including contributions)	2013-12-31	$16,244,162
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$6,015,826
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$5,864,721
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$5,843,947
Value of total assets at end of year	2013-12-31	$75,860,453
Value of total assets at beginning of year	2013-12-31	$65,694,163
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$151,105
Total interest from all sources	2013-12-31	$276,008
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$3,043,698
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	$3,043,698
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$3,867,664
Participant contributions at end of year	2013-12-31	$1,340,368
Participant contributions at beginning of year	2013-12-31	$1,411,072
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$3,154
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$122,326
Other income not declared elsewhere	2013-12-31	$-444,721
Administrative expenses (other) incurred	2013-12-31	$151,105
Liabilities. Value of operating payables at end of year	2013-12-31	$38,648
Liabilities. Value of operating payables at beginning of year	2013-12-31	$100,694
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	$10,228,336
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$75,821,805
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$65,593,469
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	$62,881,609
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$52,400,594
Interest on participant loans	2013-12-31	$43,749
Interest earned on other investments	2013-12-31	$232,259
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$10,044,565
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$10,280,404
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$7,340,521
Net investment gain/loss from pooled separate accounts	2013-12-31	$184,709
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	Yes
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	$1,853,957
Employer contributions (assets) at end of year	2013-12-31	$1,593,911
Employer contributions (assets) at beginning of year	2013-12-31	$1,598,939
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$5,864,721
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, PLLC
Accountancy firm EIN	2013-12-31	381357951
2012 : MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS 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	$100,694
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$13,341,098
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$4,824,620
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$4,689,256
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$6,427,198
Value of total assets at end of year	2012-12-31	$65,694,163
Value of total assets at beginning of year	2012-12-31	$57,076,991
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$135,364
Total interest from all sources	2012-12-31	$250,346
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$1,600,118
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	$1,600,118
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$2,453,437
Participant contributions at end of year	2012-12-31	$1,411,072
Participant contributions at beginning of year	2012-12-31	$1,497,710
Participant contributions at end of year	2012-12-31	$3,154
Participant contributions at beginning of year	2012-12-31	$122,908
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$133,272
Other income not declared elsewhere	2012-12-31	$152,518
Liabilities. Value of operating payables at end of year	2012-12-31	$100,694
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	$8,516,478
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$65,593,469
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$57,076,991
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
Investment advisory and management fees	2012-12-31	$135,364
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$52,400,594
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$44,026,307
Interest on participant loans	2012-12-31	$57,704
Interest earned on other investments	2012-12-31	$192,642
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$10,280,404
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$9,900,971
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$4,910,918
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	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$3,840,489
Employer contributions (assets) at end of year	2012-12-31	$1,598,939
Employer contributions (assets) at beginning of year	2012-12-31	$1,529,095
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$4,689,256
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	2012-12-31	No
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, PLLC
Accountancy firm EIN	2012-12-31	381357951
2011 : MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$32,319
Total income from all sources (including contributions)	2011-12-31	$4,687,211
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$4,093,051
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$4,004,387
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$5,232,976
Value of total assets at end of year	2011-12-31	$56,631,940
Value of total assets at beginning of year	2011-12-31	$56,070,099
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$88,664
Total interest from all sources	2011-12-31	$309,693
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$1,395,324
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	$1,395,324
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
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	$3,309,793
Participant contributions at end of year	2011-12-31	$1,497,710
Participant contributions at beginning of year	2011-12-31	$1,353,796
Participant contributions at end of year	2011-12-31	$122,908
Assets. Other investments not covered elsewhere at end of year	2011-12-31	$9,455,920
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$9,145,653
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$132,072
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$32,319
Other income not declared elsewhere	2011-12-31	$142,629
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	$594,160
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$56,631,940
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$56,037,780
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
Investment advisory and management fees	2011-12-31	$88,664
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$44,026,307
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$44,184,281
Interest on participant loans	2011-12-31	$65,278
Interest earned on other investments	2011-12-31	$244,415
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-2,393,411
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	$1,791,111
Employer contributions (assets) at end of year	2011-12-31	$1,529,095
Employer contributions (assets) at beginning of year	2011-12-31	$1,386,369
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$4,004,387
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	2011-12-31	No
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, PLLC
Accountancy firm EIN	2011-12-31	381357951
2010 : MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$70,725
Total unrealized appreciation/depreciation of assets	2010-12-31	$70,725
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$32,319
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$39,515
Total income from all sources (including contributions)	2010-12-31	$10,367,913
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$5,222,026
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$5,139,778
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$4,262,838
Value of total assets at end of year	2010-12-31	$56,070,099
Value of total assets at beginning of year	2010-12-31	$50,931,408
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$82,248
Total interest from all sources	2010-12-31	$300,752
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$1,141,082
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	$1,141,082
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$2,859,104
Participant contributions at end of year	2010-12-31	$1,353,796
Participant contributions at beginning of year	2010-12-31	$1,273,235
Participant contributions at beginning of year	2010-12-31	$49
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$9,145,653
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$8,120,983
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$17,235
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$14,085
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$32,319
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$39,515
Administrative expenses (other) incurred	2010-12-31	$45,432
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	$5,145,887
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$56,037,780
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$50,891,893
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
Investment advisory and management fees	2010-12-31	$36,816
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$44,184,281
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$40,797,127
Interest on participant loans	2010-12-31	$70,957
Interest earned on other investments	2010-12-31	$229,795
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$85,494
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$85,494
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$4,592,516
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	$1,386,499
Employer contributions (assets) at end of year	2010-12-31	$1,386,369
Employer contributions (assets) at beginning of year	2010-12-31	$640,435
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$5,139,778
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	2010-12-31	No
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	PLANTE & MORAN, PLLC
Accountancy firm EIN	2010-12-31	381357951

Form 5500 Responses for MERCY MEMORIAL HOSPITAL SYSTEM RETIREMENT SAVINGS PLAN

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

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6072

Policy instance

Insurance contract or identification number	VF6072
Number of Individuals Covered	92
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,019
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

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

32301

Policy instance

Insurance contract or identification number	32301
Number of Individuals Covered	1849
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $10,249
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?	Yes
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?	Yes

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

32301

Policy instance

Insurance contract or identification number	32301
Number of Individuals Covered	672
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $12,743
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?	Yes
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
Commission paid to Insurance Broker	USD $12,743
Insurance broker organization code?	3
Insurance broker name	METLIFE SECURITIES INC.

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6072

Policy instance

Insurance contract or identification number	VF6072
Number of Individuals Covered	92
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,979
Total amount of fees paid to insurance company	USD $1
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 $1,971
Insurance broker organization code?	3
Amount paid for insurance broker fees	1
Additional information about fees paid to insurance broker	ALLOCATED NON-CASH COMP
Insurance broker name	CARDONE TOBIAS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

32301

Policy instance

Insurance contract or identification number	32301
Number of Individuals Covered	678
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
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?	Yes
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6072

Policy instance

Insurance contract or identification number	VF6072
Number of Individuals Covered	92
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,138
Total amount of fees paid to insurance company	USD $5
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 $1,763
Insurance broker organization code?	3
Amount paid for insurance broker fees	5
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH AND ALLOCATED NON-CASH COMP
Insurance broker name	CARDONE TOBIAS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

32301

Policy instance

Insurance contract or identification number	32301
Number of Individuals Covered	1971
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $11,347
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?	Yes
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
Commission paid to Insurance Broker	USD $11,347
Insurance broker organization code?	3
Insurance broker name	METLIFE SECURITIES INC.

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6072

Policy instance

Insurance contract or identification number	VF6072
Number of Individuals Covered	94
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,342
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?	Yes
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
Commission paid to Insurance Broker	USD $2,037
Insurance broker organization code?	3
Insurance broker name	CARDONE TOBIAS

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6072

Policy instance

Insurance contract or identification number	VF6072
Number of Individuals Covered	92
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,899
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?	Yes
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

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

32301

Policy instance

Insurance contract or identification number	32301
Number of Individuals Covered	1971
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
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?	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?	Yes
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6072

Policy instance

Insurance contract or identification number	VF6072
Number of Individuals Covered	92
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,560
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?	Yes
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

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

32301

Policy instance

Insurance contract or identification number	32301
Number of Individuals Covered	1191
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?	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?	Yes
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

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Company Name:	PROMEDICA
Employer identification number (EIN):	381984289
NAIC Classification:	622000
NAIC Description:	Hospitals