401k Plan data: MIDMICHIGAN HEALTH FROZEN 401A PLAN plan

MIDMICHIGAN HEALTH FROZEN 401A PLAN 401k Plan overview

Plan Name	MIDMICHIGAN HEALTH FROZEN 401A PLAN
Plan identification number	002

MIDMICHIGAN HEALTH FROZEN 401A PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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.
Participant-directed brokerage accounts provided as an investment option under the plan.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

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

Company Name: MYMICHIGAN HEALTH

Employer identification number (EIN): 382459948

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about MYMICHIGAN HEALTH

Jurisdiction of Incorporation: Michigan Department of Licensing & Regulatory Affairs

Incorporation Date:

Company Identification Number: 716746

More information about MYMICHIGAN HEALTH

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MIDMICHIGAN HEALTH FROZEN 401A PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2015-01-01 SHERYL DALLAIRE SHERYL DALLAIRE 2016-07-19
002 2014-01-01 SHERYL DALLAIRE SHERYL DALLAIRE 2015-09-17
002 2013-01-01 KATELYN HENIKA
002 2012-01-01 CHERYL ZIMMERMAN
002 2011-01-01 GREG GHILARDI
002 2009-01-01 GREG GHILARDI
002 2009-01-01 GREG GHILARDI

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2015-01-01	SHERYL DALLAIRE	SHERYL DALLAIRE	2016-07-19
002	2014-01-01	SHERYL DALLAIRE	SHERYL DALLAIRE	2015-09-17
002	2013-01-01	KATELYN HENIKA
002	2012-01-01	CHERYL ZIMMERMAN
002	2011-01-01	GREG GHILARDI
002	2009-01-01	GREG GHILARDI
002	2009-01-01	GREG GHILARDI

Plan Statistics for MIDMICHIGAN HEALTH FROZEN 401A PLAN

401k plan membership statisitcs for MIDMICHIGAN HEALTH FROZEN 401A PLAN

Measure Date Value
2015: MIDMICHIGAN HEALTH FROZEN 401A PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 823
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: MIDMICHIGAN HEALTH FROZEN 401A PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 975
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 746
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 76
Total of all active and inactive participants 2014-01-01 823
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 823
Number of participants with account balances 2014-01-01 823
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: MIDMICHIGAN HEALTH FROZEN 401A PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,037
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 832
Number of retired or separated participants receiving benefits 2013-01-01 2
Number of other retired or separated participants entitled to future benefits 2013-01-01 141
Total of all active and inactive participants 2013-01-01 975
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 975
Number of participants with account balances 2013-01-01 975
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: MIDMICHIGAN HEALTH FROZEN 401A PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,179
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 899
Number of retired or separated participants receiving benefits 2012-01-01 2
Number of other retired or separated participants entitled to future benefits 2012-01-01 136
Total of all active and inactive participants 2012-01-01 1,037
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 1,037
Number of participants with account balances 2012-01-01 1,037
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: MIDMICHIGAN HEALTH FROZEN 401A PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,260
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,066
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 111
Total of all active and inactive participants 2011-01-01 1,179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 1,179
Number of participants with account balances 2011-01-01 1,179
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: MIDMICHIGAN HEALTH FROZEN 401A PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,545
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,262
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 151
Total of all active and inactive participants 2009-01-01 1,413
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 1,413
Number of participants with account balances 2009-01-01 1,413
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2015: MIDMICHIGAN HEALTH FROZEN 401A PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	823
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: MIDMICHIGAN HEALTH FROZEN 401A PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	975
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	746
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	76
Total of all active and inactive participants	2014-01-01	823
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	823
Number of participants with account balances	2014-01-01	823
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: MIDMICHIGAN HEALTH FROZEN 401A PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,037
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	832
Number of retired or separated participants receiving benefits	2013-01-01	2
Number of other retired or separated participants entitled to future benefits	2013-01-01	141
Total of all active and inactive participants	2013-01-01	975
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	975
Number of participants with account balances	2013-01-01	975
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: MIDMICHIGAN HEALTH FROZEN 401A PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,179
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	899
Number of retired or separated participants receiving benefits	2012-01-01	2
Number of other retired or separated participants entitled to future benefits	2012-01-01	136
Total of all active and inactive participants	2012-01-01	1,037
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	1,037
Number of participants with account balances	2012-01-01	1,037
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: MIDMICHIGAN HEALTH FROZEN 401A PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,260
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,066
Number of retired or separated participants receiving benefits	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	111
Total of all active and inactive participants	2011-01-01	1,179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	1,179
Number of participants with account balances	2011-01-01	1,179
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: MIDMICHIGAN HEALTH FROZEN 401A PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,545
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,262
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	151
Total of all active and inactive participants	2009-01-01	1,413
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	1,413
Number of participants with account balances	2009-01-01	1,413
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on MIDMICHIGAN HEALTH FROZEN 401A PLAN

Measure	Date	Value
2015 : MIDMICHIGAN HEALTH FROZEN 401A PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-10-13	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-10-13	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-10-13	$0
Total income from all sources (including contributions)	2015-10-13	$108,496
Total loss/gain on sale of assets	2015-10-13	$0
Total of all expenses incurred	2015-10-13	$10,995,136
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-10-13	$10,867,402
Expenses. Certain deemed distributions of participant loans	2015-10-13	$29,771
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-10-13	$0
Value of total assets at end of year	2015-10-13	$0
Value of total assets at beginning of year	2015-10-13	$10,886,640
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-10-13	$97,963
Total interest from all sources	2015-10-13	$28,335
Total dividends received (eg from common stock, registered investment company shares)	2015-10-13	$38,826
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-10-13	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2015-10-13	$0
Total dividends received from registered investment company shares (eg mutual funds)	2015-10-13	$38,826
Was this plan covered by a fidelity bond	2015-10-13	Yes
Value of fidelity bond cover	2015-10-13	$5,000,000
If this is an individual account plan, was there a blackout period	2015-10-13	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-10-13	$0
Were there any nonexempt tranactions with any party-in-interest	2015-10-13	No
Participant contributions at end of year	2015-10-13	$0
Participant contributions at beginning of year	2015-10-13	$157,329
Other income not declared elsewhere	2015-10-13	$42,601
Administrative expenses (other) incurred	2015-10-13	$97,963
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-10-13	No
Value of net income/loss	2015-10-13	$-10,886,640
Value of net assets at end of year (total assets less liabilities)	2015-10-13	$0
Value of net assets at beginning of year (total assets less liabilities)	2015-10-13	$10,886,640
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-10-13	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-10-13	No
Were any leases to which the plan was party in default or uncollectible	2015-10-13	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-10-13	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-10-13	$8,909,895
Interest on participant loans	2015-10-13	$3,746
Interest earned on other investments	2015-10-13	$24,589
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-10-13	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-10-13	$1,819,416
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-10-13	$-1,266
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-10-13	No
Was there a failure to transmit to the plan any participant contributions	2015-10-13	No
Has the plan failed to provide any benefit when due under the plan	2015-10-13	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-10-13	$10,867,402
Did the plan have assets held for investment	2015-10-13	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	2015-10-13	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-10-13	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-10-13	Yes
Opinion of an independent qualified public accountant for this plan	2015-10-13	Disclaimer
Accountancy firm name	2015-10-13	PLANTE MORAN
Accountancy firm EIN	2015-10-13	381357951
2014 : MIDMICHIGAN HEALTH FROZEN 401A PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$584,270
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$2,349,907
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$2,257,443
Expenses. Certain deemed distributions of participant loans	2014-12-31	$18,545
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$0
Value of total assets at end of year	2014-12-31	$10,886,640
Value of total assets at beginning of year	2014-12-31	$12,652,277
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$73,919
Total interest from all sources	2014-12-31	$53,844
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$120,585
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	$120,585
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Participant contributions at end of year	2014-12-31	$157,329
Participant contributions at beginning of year	2014-12-31	$199,209
Other income not declared elsewhere	2014-12-31	$1,843
Administrative expenses (other) incurred	2014-12-31	$73,919
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	$-1,765,637
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$10,886,640
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$12,652,277
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	$8,909,895
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$10,097,413
Interest on participant loans	2014-12-31	$7,356
Interest earned on other investments	2014-12-31	$46,488
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$1,819,416
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$2,355,655
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$407,998
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$2,257,443
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 AND MORAN
Accountancy firm EIN	2014-12-31	381357951
2013 : MIDMICHIGAN HEALTH FROZEN 401A PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$2,035,618
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$853,937
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$817,238
Expenses. Certain deemed distributions of participant loans	2013-12-31	$34,504
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$0
Value of total assets at end of year	2013-12-31	$12,652,277
Value of total assets at beginning of year	2013-12-31	$11,470,596
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$2,195
Total interest from all sources	2013-12-31	$52,491
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$117,522
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	$117,522
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Participant contributions at end of year	2013-12-31	$199,209
Participant contributions at beginning of year	2013-12-31	$214,846
Administrative expenses (other) incurred	2013-12-31	$2,195
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	$1,181,681
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$12,652,277
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$11,470,596
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	$10,097,413
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$8,799,893
Interest on participant loans	2013-12-31	$9,162
Interest earned on other investments	2013-12-31	$43,329
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$2,355,655
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$2,455,857
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$1,865,605
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$817,238
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 AND MORAN
Accountancy firm EIN	2013-12-31	381357951
2012 : MIDMICHIGAN HEALTH FROZEN 401A PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$1,142,527
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$1,484,601
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$1,421,292
Expenses. Certain deemed distributions of participant loans	2012-12-31	$61,222
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$0
Value of total assets at end of year	2012-12-31	$11,470,596
Value of total assets at beginning of year	2012-12-31	$11,812,670
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$2,087
Total interest from all sources	2012-12-31	$66,707
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$141,356
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	$141,356
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Participant contributions at end of year	2012-12-31	$214,846
Participant contributions at beginning of year	2012-12-31	$330,585
Administrative expenses (other) incurred	2012-12-31	$2,087
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	$-342,074
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$11,470,596
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$11,812,670
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	$8,799,893
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$8,871,260
Interest on participant loans	2012-12-31	$11,266
Interest earned on other investments	2012-12-31	$55,441
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$2,455,857
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$2,610,825
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$934,464
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$1,421,292
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 AND MORAN
Accountancy firm EIN	2012-12-31	381357951
2011 : MIDMICHIGAN HEALTH FROZEN 401A 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	$0
Total income from all sources (including contributions)	2011-12-31	$-167,468
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$721,762
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$624,024
Expenses. Certain deemed distributions of participant loans	2011-12-31	$94,717
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$0
Value of total assets at end of year	2011-12-31	$11,812,670
Value of total assets at beginning of year	2011-12-31	$12,701,900
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$3,021
Total interest from all sources	2011-12-31	$80,698
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$150,114
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	$150,114
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Participant contributions at end of year	2011-12-31	$330,585
Participant contributions at beginning of year	2011-12-31	$356,771
Administrative expenses (other) incurred	2011-12-31	$3,021
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	$-889,230
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$11,812,670
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$12,701,900
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$8,871,260
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$9,775,130
Interest on participant loans	2011-12-31	$16,244
Interest earned on other investments	2011-12-31	$64,454
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$2,610,825
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$2,569,999
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-398,280
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$624,024
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 AND MORAN
Accountancy firm EIN	2011-12-31	381357951
2010 : MIDMICHIGAN HEALTH FROZEN 401A PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$1,269,145
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$1,390,767
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,233,806
Expenses. Certain deemed distributions of participant loans	2010-12-31	$151,118
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$0
Value of total assets at end of year	2010-12-31	$12,701,900
Value of total assets at beginning of year	2010-12-31	$12,823,522
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$5,843
Total interest from all sources	2010-12-31	$90,772
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$146,089
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	$146,089
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Participant contributions at end of year	2010-12-31	$356,771
Participant contributions at beginning of year	2010-12-31	$334,580
Administrative expenses (other) incurred	2010-12-31	$5,843
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	$-121,622
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$12,701,900
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$12,823,522
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	$9,775,130
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$9,673,450
Interest on participant loans	2010-12-31	$17,444
Interest earned on other investments	2010-12-31	$73,328
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$2,569,999
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$2,815,492
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$1,032,284
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,233,806
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 AND MORAN
Accountancy firm EIN	2010-12-31	381357951
2009 : MIDMICHIGAN HEALTH FROZEN 401A PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0
2008 : MIDMICHIGAN HEALTH FROZEN 401A PLAN 2008 401k financial data
Total unrealized appreciation/depreciation of assets	2008-12-31	$0
Total transfer of assets to this plan	2008-12-31	$15,417,851
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2008-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2008-12-31	$0
Total income from all sources (including contributions)	2008-12-31	$-2,239,407
Total loss/gain on sale of assets	2008-12-31	$0
Total of all expenses incurred	2008-12-31	$1,611,340
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2008-12-31	$1,567,093
Expenses. Certain deemed distributions of participant loans	2008-12-31	$38,954
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2008-12-31	$658,929
Value of total assets at end of year	2008-12-31	$11,567,104
Value of total assets at beginning of year	2008-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2008-12-31	$5,293
Total interest from all sources	2008-12-31	$81,386
Total dividends received (eg from common stock, registered investment company shares)	2008-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2008-12-31	No
Was this plan covered by a fidelity bond	2008-12-31	Yes
Value of fidelity bond cover	2008-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2008-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2008-12-31	No
Participant contributions at end of year	2008-12-31	$367,562
Participant contributions at beginning of year	2008-12-31	$0
Administrative expenses (other) incurred	2008-12-31	$5,293
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2008-12-31	No
Value of net income/loss	2008-12-31	$-3,850,747
Value of net assets at end of year (total assets less liabilities)	2008-12-31	$11,567,104
Value of net assets at beginning of year (total assets less liabilities)	2008-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2008-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2008-12-31	No
Were any leases to which the plan was party in default or uncollectible	2008-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2008-12-31	$9,767,197
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2008-12-31	$0
Interest on participant loans	2008-12-31	$31,344
Interest earned on other investments	2008-12-31	$50,042
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2008-12-31	$1,432,345
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2008-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2008-12-31	$-2,979,722
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2008-12-31	No
Was there a failure to transmit to the plan any participant contributions	2008-12-31	No
Has the plan failed to provide any benefit when due under the plan	2008-12-31	No
Contributions received in cash from employer	2008-12-31	$658,929
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2008-12-31	$1,567,093
Did the plan have assets held for investment	2008-12-31	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	2008-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2008-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2008-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2008-12-31	Disclaimer
Accountancy firm name	2008-12-31	PLANTE & MORAN
Accountancy firm EIN	2008-12-31	382459948

Form 5500 Responses for MIDMICHIGAN HEALTH FROZEN 401A PLAN

2015: MIDMICHIGAN HEALTH FROZEN 401A 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)	Yes
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: MIDMICHIGAN HEALTH FROZEN 401A 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: MIDMICHIGAN HEALTH FROZEN 401A 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: MIDMICHIGAN HEALTH FROZEN 401A 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: MIDMICHIGAN HEALTH FROZEN 401A 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: MIDMICHIGAN HEALTH FROZEN 401A 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

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

007121

Policy instance

Insurance contract or identification number	007121
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-10-13
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?	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

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

007121

Policy instance

Insurance contract or identification number	007121
Number of Individuals Covered	823
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?	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

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

007121

Policy instance

Insurance contract or identification number	007121
Number of Individuals Covered	975
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?	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

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

007121

Policy instance

Insurance contract or identification number	007121
Number of Individuals Covered	1037
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
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?	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

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

007121

Policy instance

Insurance contract or identification number	007121
Number of Individuals Covered	1179
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?	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

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

007121

Policy instance

Insurance contract or identification number	007121
Number of Individuals Covered	1260
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?	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

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

007121

Policy instance

Insurance contract or identification number	007121
Number of Individuals Covered	1545
Insurance policy start date	2008-11-28
Insurance policy end date	2008-12-31
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?	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

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Company Name:	MYMICHIGAN HEALTH
Employer identification number (EIN):	382459948
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Michigan Department of Licensing & Regulatory Affairs
Incorporation Date:
Company Identification Number:	716746