401k Plan data: JENNIE STUART MEDICAL CENTER 403(B) PLAN plan

JENNIE STUART MEDICAL CENTER 403(B) PLAN 401k Plan overview

Plan Name	JENNIE STUART MEDICAL CENTER 403(B) PLAN
Plan identification number	003

JENNIE STUART MEDICAL CENTER 403(B) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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.
Plan sponsor(s) received services of leased employees, as defined in Code section 414(n), during the plan year.

401k Sponsoring company profile

JENNIE STUART MEDICAL CENTER has sponsored the creation of one or more 401k plans.

Company Name: JENNIE STUART MEDICAL CENTER

Employer identification number (EIN): 610482973

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JENNIE STUART MEDICAL CENTER 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2022-01-01
003 2021-01-01
003 2020-01-01
003 2019-01-01
003 2018-01-01
003 2017-01-01 PRISCILLA PRATER GREG MOORE 2018-10-05
003 2016-05-01 RICK SCOTT GREG MOORE 2017-10-16

Plan Statistics for JENNIE STUART MEDICAL CENTER 403(B) PLAN

401k plan membership statisitcs for JENNIE STUART MEDICAL CENTER 403(B) PLAN

Measure Date Value
2022: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,124
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,149
Number of retired or separated participants receiving benefits 2022-01-01 6
Number of other retired or separated participants entitled to future benefits 2022-01-01 108
Total of all active and inactive participants 2022-01-01 1,263
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 1,263
Number of participants with account balances 2022-01-01 541
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 5
2021: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 918
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 998
Number of retired or separated participants receiving benefits 2021-01-01 7
Number of other retired or separated participants entitled to future benefits 2021-01-01 99
Total of all active and inactive participants 2021-01-01 1,104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 1,104
Number of participants with account balances 2021-01-01 485
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 11
2020: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,021
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 825
Number of retired or separated participants receiving benefits 2020-01-01 9
Number of other retired or separated participants entitled to future benefits 2020-01-01 82
Total of all active and inactive participants 2020-01-01 916
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 916
Number of participants with account balances 2020-01-01 440
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 18
2019: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 931
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 961
Number of retired or separated participants receiving benefits 2019-01-01 4
Number of other retired or separated participants entitled to future benefits 2019-01-01 56
Total of all active and inactive participants 2019-01-01 1,021
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 1,021
Number of participants with account balances 2019-01-01 437
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 14
2018: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 907
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 887
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 44
Total of all active and inactive participants 2018-01-01 931
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 931
Number of participants with account balances 2018-01-01 404
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 14
2017: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 900
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 873
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 34
Total of all active and inactive participants 2017-01-01 907
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 907
Number of participants with account balances 2017-01-01 406
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 11
2016: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-05-01 859
Total number of active participants reported on line 7a of the Form 5500 2016-05-01 880
Number of retired or separated participants receiving benefits 2016-05-01 0
Number of other retired or separated participants entitled to future benefits 2016-05-01 17
Total of all active and inactive participants 2016-05-01 897
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-05-01 0
Total participants 2016-05-01 897
Number of participants with account balances 2016-05-01 354
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-05-01 0

Measure	Date	Value
2022: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,124
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,149
Number of retired or separated participants receiving benefits	2022-01-01	6
Number of other retired or separated participants entitled to future benefits	2022-01-01	108
Total of all active and inactive participants	2022-01-01	1,263
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	1,263
Number of participants with account balances	2022-01-01	541
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	5
2021: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	918
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	998
Number of retired or separated participants receiving benefits	2021-01-01	7
Number of other retired or separated participants entitled to future benefits	2021-01-01	99
Total of all active and inactive participants	2021-01-01	1,104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	1,104
Number of participants with account balances	2021-01-01	485
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	11
2020: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,021
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	825
Number of retired or separated participants receiving benefits	2020-01-01	9
Number of other retired or separated participants entitled to future benefits	2020-01-01	82
Total of all active and inactive participants	2020-01-01	916
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	916
Number of participants with account balances	2020-01-01	440
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	18
2019: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	931
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	961
Number of retired or separated participants receiving benefits	2019-01-01	4
Number of other retired or separated participants entitled to future benefits	2019-01-01	56
Total of all active and inactive participants	2019-01-01	1,021
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	1,021
Number of participants with account balances	2019-01-01	437
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	14
2018: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	907
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	887
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	44
Total of all active and inactive participants	2018-01-01	931
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	931
Number of participants with account balances	2018-01-01	404
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	14
2017: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	900
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	873
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	34
Total of all active and inactive participants	2017-01-01	907
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	907
Number of participants with account balances	2017-01-01	406
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	11
2016: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-05-01	859
Total number of active participants reported on line 7a of the Form 5500	2016-05-01	880
Number of retired or separated participants receiving benefits	2016-05-01	0
Number of other retired or separated participants entitled to future benefits	2016-05-01	17
Total of all active and inactive participants	2016-05-01	897
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-05-01	0
Total participants	2016-05-01	897
Number of participants with account balances	2016-05-01	354
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-05-01	0

Financial Data on JENNIE STUART MEDICAL CENTER 403(B) PLAN

Measure	Date	Value
2022 : JENNIE STUART MEDICAL CENTER 403(B) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-1,119,220
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$1,217,512
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$1,117,901
Value of total corrective distributions	2022-12-31	$109
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$3,315,831
Value of total assets at end of year	2022-12-31	$25,701,703
Value of total assets at beginning of year	2022-12-31	$28,038,435
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$99,502
Total interest from all sources	2022-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$1,192,155
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$1,192,155
Administrative expenses professional fees incurred	2022-12-31	$8,729
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$2,298,018
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$215,642
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-2,336,732
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$25,701,703
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$28,038,435
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$34,450
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$24,215,893
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$26,745,434
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$683,639
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$640,664
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-5,627,206
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$802,171
Employer contributions (assets) at end of year	2022-12-31	$802,171
Employer contributions (assets) at beginning of year	2022-12-31	$652,337
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$1,117,901
Contract administrator fees	2022-12-31	$56,323
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	MCM CPS'S & ADVISORS LLP
Accountancy firm EIN	2022-12-31	271235638
2021 : JENNIE STUART MEDICAL CENTER 403(B) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$6,214,712
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$1,505,125
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$1,414,853
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$2,718,157
Value of total assets at end of year	2021-12-31	$28,038,435
Value of total assets at beginning of year	2021-12-31	$23,328,848
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$90,272
Total interest from all sources	2021-12-31	$11,831
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$1,344,072
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$1,344,072
Administrative expenses professional fees incurred	2021-12-31	$8,570
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$2,030,757
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$35,063
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$4,709,587
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$28,038,435
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$23,328,848
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$31,250
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$26,745,434
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$22,515,517
Interest earned on other investments	2021-12-31	$11,831
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$640,664
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$241,011
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$2,140,652
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$652,337
Employer contributions (assets) at end of year	2021-12-31	$652,337
Employer contributions (assets) at beginning of year	2021-12-31	$572,320
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$1,414,853
Contract administrator fees	2021-12-31	$50,452
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	MCM CPAS & ADVISORS LLP
Accountancy firm EIN	2021-12-31	271235638
2020 : JENNIE STUART MEDICAL CENTER 403(B) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$5,691,127
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$1,363,515
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$1,289,161
Value of total corrective distributions	2020-12-31	$5,570
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$2,451,544
Value of total assets at end of year	2020-12-31	$23,328,848
Value of total assets at beginning of year	2020-12-31	$19,001,236
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$68,784
Total interest from all sources	2020-12-31	$5,608
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$816,437
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$816,437
Administrative expenses professional fees incurred	2020-12-31	$8,161
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$1,739,853
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$139,371
Total non interest bearing cash at end of year	2020-12-31	$0
Total non interest bearing cash at beginning of year	2020-12-31	$2,963
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$4,327,612
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$23,328,848
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$19,001,236
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$18,750
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$22,515,517
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$18,195,820
Interest earned on other investments	2020-12-31	$5,608
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$241,011
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$208,605
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$2,417,538
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$572,320
Employer contributions (assets) at end of year	2020-12-31	$572,320
Employer contributions (assets) at beginning of year	2020-12-31	$593,848
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$1,289,161
Contract administrator fees	2020-12-31	$41,873
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	MCM CPAS & ADVISORS LLP
Accountancy firm EIN	2020-12-31	271235638
2019 : JENNIE STUART MEDICAL CENTER 403(B) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$5,469,180
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$1,073,820
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$1,000,243
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$2,361,387
Value of total assets at end of year	2019-12-31	$19,001,236
Value of total assets at beginning of year	2019-12-31	$14,605,876
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$73,577
Total interest from all sources	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$1,039,329
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$1,039,329
Administrative expenses professional fees incurred	2019-12-31	$5,701
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$1,743,133
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$24,406
Other income not declared elsewhere	2019-12-31	$6,114
Total non interest bearing cash at end of year	2019-12-31	$2,963
Total non interest bearing cash at beginning of year	2019-12-31	$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	2019-12-31	No
Value of net income/loss	2019-12-31	$4,395,360
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$19,001,236
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$14,605,876
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$18,833
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$18,195,820
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$13,848,706
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$208,605
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$187,844
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$2,062,350
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$593,848
Employer contributions (assets) at end of year	2019-12-31	$593,848
Employer contributions (assets) at beginning of year	2019-12-31	$569,326
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,000,243
Contract administrator fees	2019-12-31	$49,043
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	MCM CPAS & ADVISORS LLP
Accountancy firm EIN	2019-12-31	271235638
2018 : JENNIE STUART MEDICAL CENTER 403(B) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$1,553,846
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$1,061,590
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$989,326
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$2,228,218
Value of total assets at end of year	2018-12-31	$14,605,876
Value of total assets at beginning of year	2018-12-31	$14,113,620
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$72,264
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$639,696
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$639,696
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$1,596,247
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$62,645
Other income not declared elsewhere	2018-12-31	$4,492
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$492,256
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$14,605,876
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$14,113,620
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$21,250
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$13,848,706
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$13,401,696
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$187,844
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$168,349
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-1,318,560
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$569,326
Employer contributions (assets) at end of year	2018-12-31	$569,326
Employer contributions (assets) at beginning of year	2018-12-31	$543,575
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$989,326
Contract administrator fees	2018-12-31	$51,014
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	MCM CPAS & ADVISORS LLP
Accountancy firm EIN	2018-12-31	271235638
2017 : JENNIE STUART MEDICAL CENTER 403(B) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$13,148,595
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$436,362
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$361,956
Value of total corrective distributions	2017-12-31	$3,900
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$11,472,113
Value of total assets at end of year	2017-12-31	$14,113,620
Value of total assets at beginning of year	2017-12-31	$1,401,387
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$70,506
Total interest from all sources	2017-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$357,469
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$357,469
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$1,552,953
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$9,375,585
Other income not declared elsewhere	2017-12-31	$3,188
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$12,712,233
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$14,113,620
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,401,387
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Investment advisory and management fees	2017-12-31	$27,025
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$13,401,696
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$1,020,315
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$168,349
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$13,470
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$1,315,825
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$543,575
Employer contributions (assets) at end of year	2017-12-31	$543,575
Employer contributions (assets) at beginning of year	2017-12-31	$367,602
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$361,956
Contract administrator fees	2017-12-31	$43,481
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	MCM CPAS & ADVISORS LLP
Accountancy firm EIN	2017-12-31	271235638
2016 : JENNIE STUART MEDICAL CENTER 403(B) 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	$1,430,539
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$29,152
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$11,286
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$1,405,865
Value of total assets at end of year	2016-12-31	$1,401,387
Value of total assets at beginning of year	2016-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$17,866
Total interest from all sources	2016-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$33,393
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$33,393
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$1,034,181
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$4,082
Other income not declared elsewhere	2016-12-31	$92
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	$1,401,387
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$1,401,387
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$0
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
Investment advisory and management fees	2016-12-31	$1,667
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$1,020,315
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$13,470
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$-8,811
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	$367,602
Employer contributions (assets) at end of year	2016-12-31	$367,602
Employer contributions (assets) at beginning of year	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$11,286
Contract administrator fees	2016-12-31	$16,199
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	MOUNTJOY CHILTON MEDLEY, LLP
Accountancy firm EIN	2016-12-31	271235638

Form 5500 Responses for JENNIE STUART MEDICAL CENTER 403(B) PLAN

2022: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: JENNIE STUART MEDICAL CENTER 403(B) PLAN 2016 form 5500 responses
2016-05-01	Type of plan entity	Single employer plan
2016-05-01	First time form 5500 has been submitted	Yes
2016-05-01	Submission has been amended	No
2016-05-01	This submission is the final filing	No
2016-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-05-01	Plan is a collectively bargained plan	No
2016-05-01	Plan funding arrangement – Insurance	Yes
2016-05-01	Plan funding arrangement – Trust	Yes
2016-05-01	Plan benefit arrangement – Insurance	Yes
2016-05-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

810449A

Policy instance

Insurance contract or identification number	810449A
Number of Individuals Covered	21
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	0
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

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

810449A

Policy instance

Insurance contract or identification number	810449A
Number of Individuals Covered	22
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Are there contracts with allocated funds for individual policies?	0
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

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

810449A

Policy instance

Insurance contract or identification number	810449A
Number of Individuals Covered	19
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	0
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

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

810449A

Policy instance

Insurance contract or identification number	810449A
Number of Individuals Covered	18
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Are there contracts with allocated funds for individual policies?	0
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

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

810449A

Policy instance

Insurance contract or identification number	810449A
Number of Individuals Covered	20
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Are there contracts with allocated funds for individual policies?	0
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

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

810449A

Policy instance

Insurance contract or identification number	810449A
Number of Individuals Covered	21
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Are there contracts with allocated funds for individual policies?	0
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:	JENNIE STUART MEDICAL CENTER
Employer identification number (EIN):	610482973
NAIC Classification:	622000
NAIC Description:	Hospitals