401k Plan data: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN plan

CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 401k Plan overview

Plan Name	CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN
Plan identification number	002

CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 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

CITRUS MEMORIAL HEALTH FOUNDATION INC has sponsored the creation of one or more 401k plans.

Company Name: CITRUS MEMORIAL HEALTH FOUNDATION INC

Employer identification number (EIN): 592890430

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01 SANDRA CHADWICK 2017-10-19 SANDRA CHADWICK 2017-10-19
002 2016-01-01 SANDRA CHADWICK 2017-10-27 SANDRA CHADWICK 2017-10-27
002 2015-01-01 SANDRA CHADWICK SANDRA CHADWICK 2016-07-11
002 2015-01-01 SANDRA CHADWICK SANDRA CHADWICK 2017-10-16
002 2014-01-01 SANDY CHADWICK
002 2013-01-01 MARK WILLIAMS LEE GLOTZBACK 2014-10-15
002 2012-01-01 RYAN BEATY LEE GLOTZBACK 2013-10-11
002 2011-01-01 RYAN BEATY LEE GLOTZBACK 2012-10-15
002 2010-01-01 RYAN BEATY LEE GLOTZBACK 2011-10-12
002 2009-01-01 RYAN BEATY LEE GLOTZBACK 2010-12-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2016-01-01	SANDRA CHADWICK	2017-10-19	SANDRA CHADWICK	2017-10-19
002	2016-01-01	SANDRA CHADWICK	2017-10-27	SANDRA CHADWICK	2017-10-27
002	2015-01-01	SANDRA CHADWICK		SANDRA CHADWICK	2016-07-11
002	2015-01-01	SANDRA CHADWICK		SANDRA CHADWICK	2017-10-16
002	2014-01-01	SANDY CHADWICK
002	2013-01-01	MARK WILLIAMS		LEE GLOTZBACK	2014-10-15
002	2012-01-01	RYAN BEATY		LEE GLOTZBACK	2013-10-11
002	2011-01-01	RYAN BEATY		LEE GLOTZBACK	2012-10-15
002	2010-01-01	RYAN BEATY		LEE GLOTZBACK	2011-10-12
002	2009-01-01	RYAN BEATY		LEE GLOTZBACK	2010-12-01

Plan Statistics for CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN

401k plan membership statisitcs for CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN

Measure Date Value
2015: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,439
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 197
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 2015-01-01 197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 197
Number of participants with account balances 2015-01-01 197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,678
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 623
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 426
Total of all active and inactive participants 2014-01-01 1,049
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 1,049
Number of participants with account balances 2014-01-01 949
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,668
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,326
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 412
Total of all active and inactive participants 2013-01-01 1,738
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 1,738
Number of participants with account balances 2013-01-01 1,394
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 22
2012: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,777
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,410
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 458
Total of all active and inactive participants 2012-01-01 1,868
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 1,868
Number of participants with account balances 2012-01-01 1,658
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 74
2011: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,748
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,402
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 371
Total of all active and inactive participants 2011-01-01 1,773
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 1,773
Number of participants with account balances 2011-01-01 1,300
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 60
2010: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1,866
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1,463
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 477
Total of all active and inactive participants 2010-01-01 1,940
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 1,940
Number of participants with account balances 2010-01-01 1,302
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 37
2009: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,068
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,237
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 234
Total of all active and inactive participants 2009-01-01 1,471
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 1,471
Number of participants with account balances 2009-01-01 1,072
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 117

Measure	Date	Value
2015: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,439
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	197
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	197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	197
Number of participants with account balances	2015-01-01	197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,678
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	623
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	426
Total of all active and inactive participants	2014-01-01	1,049
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	1,049
Number of participants with account balances	2014-01-01	949
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,668
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,326
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	412
Total of all active and inactive participants	2013-01-01	1,738
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	1,738
Number of participants with account balances	2013-01-01	1,394
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	22
2012: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,777
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,410
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	458
Total of all active and inactive participants	2012-01-01	1,868
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	1,868
Number of participants with account balances	2012-01-01	1,658
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	74
2011: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,748
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,402
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	371
Total of all active and inactive participants	2011-01-01	1,773
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	1,773
Number of participants with account balances	2011-01-01	1,300
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	60
2010: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,866
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,463
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	477
Total of all active and inactive participants	2010-01-01	1,940
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	1,940
Number of participants with account balances	2010-01-01	1,302
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	37
2009: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,068
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,237
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	234
Total of all active and inactive participants	2009-01-01	1,471
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	1,471
Number of participants with account balances	2009-01-01	1,072
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	117

Financial Data on CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN

Measure	Date	Value
2015 : CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B 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	$458,770
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$19,247,901
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$19,015,108
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$236,838
Value of total assets at end of year	2015-12-31	$6,248,482
Value of total assets at beginning of year	2015-12-31	$25,037,613
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$232,793
Total interest from all sources	2015-12-31	$236,833
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$75,879
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
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	$75,879
Was this plan covered by a fidelity bond	2015-12-31	No
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	$22,214
Participant contributions at beginning of year	2015-12-31	$441,913
Assets. Other investments not covered elsewhere at end of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2015-12-31	$670,001
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$196,823
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
Income. Non cash contributions	2015-12-31	$0
Value of net income/loss	2015-12-31	$-18,789,131
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$6,248,482
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$25,037,613
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	$34,156
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$14,519,099
Interest on participant loans	2015-12-31	$14,248
Interest earned on other investments	2015-12-31	$236,833
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$6,192,112
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$9,406,600
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-90,780
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	$236,838
Income. Dividends from preferred stock	2015-12-31	$0
Income. Dividends from common stock	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$19,015,108
Contract administrator fees	2015-12-31	$35,970
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	No
Did the plan have assets held for investment	2015-12-31	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	POWELL AND JONES CPA
Accountancy firm EIN	2015-12-31	592145410
2014 : CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$3,656,184
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$8,951,562
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$8,893,339
Expenses. Certain deemed distributions of participant loans	2014-12-31	$1,554
Value of total corrective distributions	2014-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,967,684
Value of total assets at end of year	2014-12-31	$25,037,613
Value of total assets at beginning of year	2014-12-31	$30,332,991
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$56,669
Total interest from all sources	2014-12-31	$344,590
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$689,878
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2014-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$689,878
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$1,820,335
Participant contributions at end of year	2014-12-31	$441,913
Participant contributions at beginning of year	2014-12-31	$600,554
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$670,001
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$725,856
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$147,349
Administrative expenses (other) incurred	2014-12-31	$2,799
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	$-5,295,378
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$25,037,613
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$30,332,991
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	$14,519,099
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$17,354,278
Interest on participant loans	2014-12-31	$21,056
Interest earned on other investments	2014-12-31	$323,534
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$9,406,600
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$11,652,303
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$654,032
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	$8,893,339
Contract administrator fees	2014-12-31	$53,870
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	CARR, RIGGS & INGRAM, LLC
Accountancy firm EIN	2014-12-31	721396621
2013 : CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B 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	$7,414,916
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$3,208,899
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$3,140,747
Expenses. Certain deemed distributions of participant loans	2013-12-31	$20,133
Value of total corrective distributions	2013-12-31	$3,170
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$3,936,940
Value of total assets at end of year	2013-12-31	$30,332,991
Value of total assets at beginning of year	2013-12-31	$26,126,974
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$44,849
Total interest from all sources	2013-12-31	$338,928
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$502,797
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	$502,797
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$2,018,386
Participant contributions at end of year	2013-12-31	$600,554
Participant contributions at beginning of year	2013-12-31	$560,522
Assets. Other investments not covered elsewhere at end of year	2013-12-31	$725,856
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$597,023
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$495,551
Administrative expenses (other) incurred	2013-12-31	$2,228
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	$4,206,017
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$30,332,991
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$26,126,974
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	$17,354,278
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$13,548,637
Interest on participant loans	2013-12-31	$20,104
Interest earned on other investments	2013-12-31	$318,824
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$11,652,303
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$11,420,792
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$2,636,251
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$1,423,003
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$3,140,747
Contract administrator fees	2013-12-31	$42,621
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	PERSHING YOAKLEY ASSOCIATION
Accountancy firm EIN	2013-12-31	621517792
2012 : CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B 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	$6,463,445
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$1,706,121
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$1,631,841
Expenses. Certain deemed distributions of participant loans	2012-12-31	$20,755
Value of total corrective distributions	2012-12-31	$17,201
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$4,493,969
Value of total assets at end of year	2012-12-31	$26,126,974
Value of total assets at beginning of year	2012-12-31	$21,369,650
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$36,324
Total interest from all sources	2012-12-31	$343,091
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$333,358
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	$333,358
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$2,242,428
Participant contributions at end of year	2012-12-31	$560,522
Participant contributions at beginning of year	2012-12-31	$623,612
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$597,023
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$9,538
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$222,825
Administrative expenses (other) incurred	2012-12-31	$2,400
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	$4,757,324
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$26,126,974
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$21,369,650
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	$13,548,637
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$10,679,245
Interest on participant loans	2012-12-31	$19,608
Interest earned on other investments	2012-12-31	$323,483
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$11,420,792
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$10,057,255
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$1,293,027
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$2,028,716
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$1,631,841
Contract administrator fees	2012-12-31	$33,924
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	PERSHING YOAKLEY ASSOCIATION
Accountancy firm EIN	2012-12-31	621517792
2011 : CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B 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	$3,404,463
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$1,216,905
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,132,623
Expenses. Certain deemed distributions of participant loans	2011-12-31	$40,040
Value of total corrective distributions	2011-12-31	$8,642
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$3,375,450
Value of total assets at end of year	2011-12-31	$21,369,650
Value of total assets at beginning of year	2011-12-31	$19,182,092
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$35,600
Total interest from all sources	2011-12-31	$345,994
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$204,825
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	$204,825
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$2,106,777
Participant contributions at end of year	2011-12-31	$623,612
Participant contributions at beginning of year	2011-12-31	$692,662
Assets. Other investments not covered elsewhere at end of year	2011-12-31	$9,538
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$6,584
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$144,871
Administrative expenses (other) incurred	2011-12-31	$2,656
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	$2,187,558
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$21,369,650
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$19,182,092
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	$10,679,245
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$9,550,987
Interest on participant loans	2011-12-31	$24,279
Interest earned on other investments	2011-12-31	$321,715
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$10,057,255
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$8,931,859
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-521,806
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	$1,123,802
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,132,623
Contract administrator fees	2011-12-31	$32,944
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	PERSHING, YOAKLEY & ASSOCIATES, P.C
Accountancy firm EIN	2011-12-31	621517792
2010 : CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$10,104,270
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	$3,501,054
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$719,881
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$661,773
Expenses. Certain deemed distributions of participant loans	2010-12-31	$13,564
Value of total corrective distributions	2010-12-31	$5,628
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$2,443,596
Value of total assets at end of year	2010-12-31	$19,182,092
Value of total assets at beginning of year	2010-12-31	$6,296,649
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$38,916
Total interest from all sources	2010-12-31	$126,624
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$101,787
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	$101,787
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$1,316,236
Participant contributions at end of year	2010-12-31	$692,662
Participant contributions at beginning of year	2010-12-31	$112,025
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$6,584
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$3,517
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$76,146
Administrative expenses (other) incurred	2010-12-31	$431
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$2,781,173
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$19,182,092
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$6,296,649
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	$9,550,987
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$3,892,490
Interest on participant loans	2010-12-31	$7,885
Interest earned on other investments	2010-12-31	$118,739
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$8,931,859
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$2,288,617
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$829,047
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	$1,051,214
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$661,773
Contract administrator fees	2010-12-31	$38,485
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	PURVIS GRAY AND COMPNAY LLP
Accountancy firm EIN	2010-12-31	592890430

Form 5500 Responses for CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN

2015: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B 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: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B 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: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
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: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B 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: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B 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
2010: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: CITRUS MEMORIAL HEALTH FOUNDATION INC CODE SECTION 403B 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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

09087

Policy instance

Insurance contract or identification number	09087
Number of Individuals Covered	16
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $831
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	1
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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

09087

Policy instance

Insurance contract or identification number	09087
Number of Individuals Covered	181
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
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	1
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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

09087

Policy instance

Insurance contract or identification number	09087
Number of Individuals Covered	931
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	1
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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

09087

Policy instance

Insurance contract or identification number	09087
Number of Individuals Covered	254
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,437
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	1
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
Commission paid to Insurance Broker	USD $1,102
Insurance broker organization code?	3
Insurance broker name	FIBBE, PAUL M

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

09087

Policy instance

Insurance contract or identification number	09087
Number of Individuals Covered	1284
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	1
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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

09087

Policy instance

Insurance contract or identification number	09087
Number of Individuals Covered	301
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,052
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	1
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
Commission paid to Insurance Broker	USD $815
Insurance broker organization code?	3
Insurance broker name	NANGLE, ARTHUR J

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

09087

Policy instance

Insurance contract or identification number	09087
Number of Individuals Covered	1341
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	1
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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

09087

Policy instance

Insurance contract or identification number	09087
Number of Individuals Covered	331
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $941
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	1
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
Commission paid to Insurance Broker	USD $711
Insurance broker organization code?	3
Insurance broker name	FIBBE PAUL M

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

09087

Policy instance

Insurance contract or identification number	09087
Number of Individuals Covered	1157
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	1
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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

09087

Policy instance

Insurance contract or identification number	09087
Number of Individuals Covered	352
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,195
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	1
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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

09087

Policy instance

Insurance contract or identification number	09087
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	1
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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

09087

Policy instance

Insurance contract or identification number	09087
Number of Individuals Covered	419
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	1
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:	CITRUS MEMORIAL HEALTH FOUNDATION INC
Employer identification number (EIN):	592890430
NAIC Classification:	622000
NAIC Description:	Hospitals