401k Plan data: MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN plan

MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN 401k Plan overview

Plan Name	MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN
Plan identification number	002

MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

MILE BLUFF MEDICAL CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: MILE BLUFF MEDICAL CENTER, INC.

Employer identification number (EIN): 390992883

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01 NIKKI TURNER 2023-05-10
002 2021-01-01 NIKKI TURNER 2022-03-17 NIKKI TURNER 2022-03-17
002 2020-01-01 NIKKI TUNER 2021-05-18
002 2019-01-01 NIKKI TUNER 2020-03-24
002 2018-01-01 NIKKI TUNER 2019-04-24
002 2017-01-01 NIKKI TUNER 2018-04-06
002 2016-01-01 NIKKI TURNER
002 2015-01-01 NIKKI TURNER
002 2014-01-01 NIKKI TURNER
002 2013-01-01 NIKKI TURNER 2014-10-14
002 2012-01-01 NIKKI TURNER 2013-07-25
002 2011-01-01 NIKKI TURNER 2012-06-28
002 2010-01-01 NIKKI TURNER 2011-05-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01	NIKKI TURNER	2023-05-10
002	2021-01-01	NIKKI TURNER	2022-03-17	NIKKI TURNER	2022-03-17
002	2020-01-01	NIKKI TUNER	2021-05-18
002	2019-01-01	NIKKI TUNER	2020-03-24
002	2018-01-01	NIKKI TUNER	2019-04-24
002	2017-01-01	NIKKI TUNER	2018-04-06
002	2016-01-01	NIKKI TURNER
002	2015-01-01	NIKKI TURNER
002	2014-01-01	NIKKI TURNER
002	2013-01-01	NIKKI TURNER	2014-10-14
002	2012-01-01	NIKKI TURNER	2013-07-25
002	2011-01-01	NIKKI TURNER	2012-06-28
002	2010-01-01	NIKKI TURNER	2011-05-23

Plan Statistics for MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN

401k plan membership statisitcs for MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN

Measure Date Value
2016: MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 84
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 13
Total of all active and inactive participants 2016-01-01 97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 97
Number of participants with account balances 2016-01-01 95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 115
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 90
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 14
Total of all active and inactive participants 2015-01-01 104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 104
Number of participants with account balances 2015-01-01 100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 94
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 21
Total of all active and inactive participants 2014-01-01 115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 115
Number of participants with account balances 2014-01-01 114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2016: MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	84
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	13
Total of all active and inactive participants	2016-01-01	97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	97
Number of participants with account balances	2016-01-01	95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	115
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	90
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	14
Total of all active and inactive participants	2015-01-01	104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	104
Number of participants with account balances	2015-01-01	100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	94
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	21
Total of all active and inactive participants	2014-01-01	115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	115
Number of participants with account balances	2014-01-01	114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN

Measure	Date	Value
2016 : MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$256,122
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$140,009
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$140,009
Expenses. Certain deemed distributions of participant loans	2016-12-31	$0
Value of total corrective distributions	2016-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$0
Value of total assets at end of year	2016-12-31	$3,613,805
Value of total assets at beginning of year	2016-12-31	$3,497,692
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$0
Total interest from all sources	2016-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$0
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$116,113
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$3,613,805
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$3,497,692
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$3,271,427
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$3,225,795
Interest on participant loans	2016-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$342,378
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$271,897
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$256,122
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$140,009
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	EIDE BAILLY
Accountancy firm EIN	2016-12-31	450250958
2015 : MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$-40,589
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$501,545
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$500,995
Expenses. Certain deemed distributions of participant loans	2015-12-31	$0
Value of total corrective distributions	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$0
Value of total assets at end of year	2015-12-31	$3,497,692
Value of total assets at beginning of year	2015-12-31	$4,039,826
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$550
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$0
Participant contributions at end of year	2015-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-542,134
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$3,497,692
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$4,039,826
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	$3,225,795
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$3,661,815
Interest on participant loans	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$271,897
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$378,011
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-40,589
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$500,995
Contract administrator fees	2015-12-31	$550
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	EIDE BAILLY
Accountancy firm EIN	2015-12-31	450250958
2014 : MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA 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	$179,544
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$646,822
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$645,972
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	$4,039,826
Value of total assets at beginning of year	2014-12-31	$4,507,104
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$850
Total interest from all sources	2014-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
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
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-467,278
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$4,039,826
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$4,507,104
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	$3,661,815
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$4,229,692
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$378,011
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$277,412
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$179,544
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$645,972
Contract administrator fees	2014-12-31	$850
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	EIDE BAILLY
Accountancy firm EIN	2014-12-31	450250958

Form 5500 Responses for MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN

2016: MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – 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: MILE BLUFF MEDICAL CENTER, INC. IRS 403(B) TSA 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

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

031-80063

Policy instance

Insurance contract or identification number	031-80063
Number of Individuals Covered	100
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $430
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
Commission paid to Insurance Broker	USD $430
Amount paid for insurance broker fees	0
Insurance broker organization code?	7
Insurance broker name	AMERICAN PORTFOLIOS FINANCIAL

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

031-80063

Policy instance

Insurance contract or identification number	031-80063
Number of Individuals Covered	114
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $376
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
Commission paid to Insurance Broker	USD $376
Insurance broker organization code?	7
Insurance broker name	AMERICAN PORTFOLIOS FINANCIAL

Potentially related plans

MILE BLUFF CLINIC PROFIT SHARING PLAN [EIN = 391093998]

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Company Name:	MILE BLUFF MEDICAL CENTER, INC.
Employer identification number (EIN):	390992883
NAIC Classification:	622000
NAIC Description:	Hospitals