401k Plan data: ATMORE COMMUNITY HOSPITAL 403(B) PLAN plan

ATMORE COMMUNITY HOSPITAL 403(B) PLAN 401k Plan overview

Plan Name	ATMORE COMMUNITY HOSPITAL 403(B) PLAN
Plan identification number	001

ATMORE COMMUNITY HOSPITAL 403(B) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
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.

401k Sponsoring company profile

ESCAMBIA COUNTY ALABAMA COMMNITY HOSPITALS, INC. has sponsored the creation of one or more 401k plans.

Company Name: ESCAMBIA COUNTY ALABAMA COMMNITY HOSPITALS, INC.

Employer identification number (EIN): 631143638

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ATMORE COMMUNITY HOSPITAL 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01

Plan Statistics for ATMORE COMMUNITY HOSPITAL 403(B) PLAN

401k plan membership statisitcs for ATMORE COMMUNITY HOSPITAL 403(B) PLAN

Measure Date Value
2022: ATMORE COMMUNITY HOSPITAL 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 311
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 237
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 116
Total of all active and inactive participants 2022-01-01 353
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 353
Number of participants with account balances 2022-01-01 287
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 25
2021: ATMORE COMMUNITY HOSPITAL 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 295
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 226
Number of retired or separated participants receiving benefits 2021-01-01 2
Number of other retired or separated participants entitled to future benefits 2021-01-01 90
Total of all active and inactive participants 2021-01-01 318
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 318
Number of participants with account balances 2021-01-01 255
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 17
2020: ATMORE COMMUNITY HOSPITAL 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 259
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 239
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 31
Total of all active and inactive participants 2020-01-01 270
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 270
Number of participants with account balances 2020-01-01 244
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 4
2019: ATMORE COMMUNITY HOSPITAL 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 223
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 228
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 30
Total of all active and inactive participants 2019-01-01 258
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 258
Number of participants with account balances 2019-01-01 219
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 17

Measure	Date	Value
2022: ATMORE COMMUNITY HOSPITAL 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	311
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	237
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	116
Total of all active and inactive participants	2022-01-01	353
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	353
Number of participants with account balances	2022-01-01	287
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	25
2021: ATMORE COMMUNITY HOSPITAL 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	295
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	226
Number of retired or separated participants receiving benefits	2021-01-01	2
Number of other retired or separated participants entitled to future benefits	2021-01-01	90
Total of all active and inactive participants	2021-01-01	318
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	318
Number of participants with account balances	2021-01-01	255
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	17
2020: ATMORE COMMUNITY HOSPITAL 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	259
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	239
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	31
Total of all active and inactive participants	2020-01-01	270
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	270
Number of participants with account balances	2020-01-01	244
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	4
2019: ATMORE COMMUNITY HOSPITAL 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	223
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	228
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	30
Total of all active and inactive participants	2019-01-01	258
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	258
Number of participants with account balances	2019-01-01	219
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	17

Financial Data on ATMORE COMMUNITY HOSPITAL 403(B) PLAN

Measure	Date	Value
2022 : ATMORE COMMUNITY HOSPITAL 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	$566,328
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$357,522
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$357,522
Value of total corrective distributions	2022-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,149,748
Value of total assets at end of year	2022-12-31	$3,767,382
Value of total assets at beginning of year	2022-12-31	$3,558,576
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$0
Total interest from all sources	2022-12-31	$7,946
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
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	$517,072
Participant contributions at end of year	2022-12-31	$167,323
Participant contributions at beginning of year	2022-12-31	$124,086
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$417,166
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	$208,806
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$3,767,382
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$3,558,576
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$3,382,499
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$3,236,266
Interest on participant loans	2022-12-31	$7,944
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$2
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$217,560
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$198,224
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-591,366
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	No
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	$215,510
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$357,522
Contract administrator fees	2022-12-31	$0
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	DRAFFIN TUCKER
Accountancy firm EIN	2022-12-31	580914992
2021 : ATMORE COMMUNITY HOSPITAL 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	$1,219,273
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$136,229
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$136,229
Expenses. Certain deemed distributions of participant loans	2021-12-31	$0
Value of total corrective distributions	2021-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$875,300
Value of total assets at end of year	2021-12-31	$3,558,576
Value of total assets at beginning of year	2021-12-31	$2,475,532
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$0
Total interest from all sources	2021-12-31	$6,148
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$499,464
Participant contributions at end of year	2021-12-31	$124,086
Participant contributions at beginning of year	2021-12-31	$100,868
Participant contributions at beginning of year	2021-12-31	$15,500
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$170,754
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	$1,083,044
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$3,558,576
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$2,475,532
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$3,236,266
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$2,163,940
Interest on participant loans	2021-12-31	$6,160
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$2,420
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$2,420
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$-12
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$198,224
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$185,331
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$337,825
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	$205,082
Employer contributions (assets) at beginning of year	2021-12-31	$7,473
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$136,229
Contract administrator fees	2021-12-31	$0
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
Accountancy firm name	2021-12-31	DRAFFIN TUCKER
Accountancy firm EIN	2021-12-31	580914992
2020 : ATMORE COMMUNITY HOSPITAL 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	$1,269,208
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$51,143
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$51,143
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$972,586
Value of total assets at end of year	2020-12-31	$2,475,532
Value of total assets at beginning of year	2020-12-31	$1,257,467
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$0
Total interest from all sources	2020-12-31	$6,234
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
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	$443,175
Participant contributions at end of year	2020-12-31	$100,868
Participant contributions at beginning of year	2020-12-31	$73,375
Participant contributions at end of year	2020-12-31	$15,500
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$341,042
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	$1,218,065
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$2,475,532
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,257,467
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$2,163,940
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,021,827
Interest on participant loans	2020-12-31	$6,234
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$2,420
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$708
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$708
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$185,331
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$161,557
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$290,388
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	$188,369
Employer contributions (assets) at end of year	2020-12-31	$7,473
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$51,143
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	Disclaimer
Accountancy firm name	2020-12-31	DRAFFIN-TUCKER
Accountancy firm EIN	2020-12-31	590914992
2019 : ATMORE COMMUNITY HOSPITAL 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	$1,270,220
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$12,753
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$12,623
Value of total corrective distributions	2019-12-31	$130
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,200,535
Value of total assets at end of year	2019-12-31	$1,257,467
Value of total assets at beginning of year	2019-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$0
Total interest from all sources	2019-12-31	$584
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
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	$281,932
Participant contributions at end of year	2019-12-31	$73,375
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$718,223
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	$1,257,467
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,257,467
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$0
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$1,021,827
Interest on participant loans	2019-12-31	$584
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$708
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$161,557
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$69,101
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	$200,380
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$12,623
Contract administrator fees	2019-12-31	$0
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	DRAFFIN & TUCKER, LLP
Accountancy firm EIN	2019-12-31	580914992

Form 5500 Responses for ATMORE COMMUNITY HOSPITAL 403(B) PLAN

2022: ATMORE COMMUNITY HOSPITAL 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: ATMORE COMMUNITY HOSPITAL 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: ATMORE COMMUNITY HOSPITAL 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: ATMORE COMMUNITY HOSPITAL 403(B) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

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

Policy contract number

GAP-B2-LN3V

Policy instance

Insurance contract or identification number	GAP-B2-LN3V
Number of Individuals Covered	287
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	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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

Policy contract number

GAP-B2-LN3V

Policy instance

Insurance contract or identification number	GAP-B2-LN3V
Number of Individuals Covered	255
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	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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

Policy contract number

GAP-B2-LN3V

Policy instance

Insurance contract or identification number	GAP-B2-LN3V
Number of Individuals Covered	244
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	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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

Policy contract number

GAP-B2-LN3V

Policy instance

Insurance contract or identification number	GAP-B2-LN3V
Number of Individuals Covered	3
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	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	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	ESCAMBIA COUNTY ALABAMA COMMNITY HOSPITALS, INC.
Employer identification number (EIN):	631143638
NAIC Classification:	622000
NAIC Description:	Hospitals