401k Plan data: ONE COMMUNITY HEALTH 401(K) PLAN plan

ONE COMMUNITY HEALTH 401(K) PLAN 401k Plan overview

Plan Name	ONE COMMUNITY HEALTH 401(K) PLAN
Plan identification number	001

ONE COMMUNITY HEALTH 401(K) 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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
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

CARES DBA ONE COMMUNITY HEALTH has sponsored the creation of one or more 401k plans.

Company Name: CARES DBA ONE COMMUNITY HEALTH

Employer identification number (EIN): 680162903

NAIC Classification: 621498
NAIC Description: All Other Outpatient Care Centers

Additional information about CARES DBA ONE COMMUNITY HEALTH

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C1619150

More information about CARES DBA ONE COMMUNITY HEALTH

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ONE COMMUNITY HEALTH 401(K) 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 2020-01-01
001 2019-01-01
001 2018-01-01
001 2018-01-01
001 2017-01-01 BRYAN JACOBSON
001 2016-01-01 ALEXANDRA STEPHENS-AKAKA
001 2015-01-01 ALEXANDRA STEPHENS
001 2014-01-01 ALEXANDRA STEPHENS 2015-10-15
001 2013-01-01 ALEXANDRA STEPHENS 2014-10-14
001 2012-01-01 ALEXANDRA STEPHENS ROBERT KAMRATH 2013-07-31
001 2011-01-01 ALEXANDRA STEPHENS ROBERT KAMRATH 2012-07-18
001 2009-01-01 ALEXANDRA STEPHENS

Plan Statistics for ONE COMMUNITY HEALTH 401(K) PLAN

401k plan membership statisitcs for ONE COMMUNITY HEALTH 401(K) PLAN

Measure Date Value
2022: ONE COMMUNITY HEALTH 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 401
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 254
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 201
Total of all active and inactive participants 2022-01-01 455
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 455
Number of participants with account balances 2022-01-01 441
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: ONE COMMUNITY HEALTH 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 363
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 306
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 93
Total of all active and inactive participants 2021-01-01 401
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 401
Number of participants with account balances 2021-01-01 390
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: ONE COMMUNITY HEALTH 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 352
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 243
Number of retired or separated participants receiving benefits 2020-01-01 21
Number of other retired or separated participants entitled to future benefits 2020-01-01 112
Total of all active and inactive participants 2020-01-01 376
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 376
Number of participants with account balances 2020-01-01 370
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 8
2019: ONE COMMUNITY HEALTH 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 285
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 244
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 99
Total of all active and inactive participants 2019-01-01 343
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 343
Number of participants with account balances 2019-01-01 337
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 10
2018: ONE COMMUNITY HEALTH 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 209
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 210
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 66
Total of all active and inactive participants 2018-01-01 276
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 276
Number of participants with account balances 2018-01-01 272
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 14
2017: ONE COMMUNITY HEALTH 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 189
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 171
Number of other retired or separated participants entitled to future benefits 2017-01-01 37
Total of all active and inactive participants 2017-01-01 208
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 208
Number of participants with account balances 2017-01-01 185
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 12
2016: ONE COMMUNITY HEALTH 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 153
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 163
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 26
Total of all active and inactive participants 2016-01-01 189
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 189
Number of participants with account balances 2016-01-01 162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 7
2015: ONE COMMUNITY HEALTH 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 134
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 19
Total of all active and inactive participants 2015-01-01 153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 153
Number of participants with account balances 2015-01-01 114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2012: ONE COMMUNITY HEALTH 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 78
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 79
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 9
Total of all active and inactive participants 2012-01-01 88
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 89
Number of participants with account balances 2012-01-01 80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 8
2011: ONE COMMUNITY HEALTH 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 83
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 73
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 73
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 73
Number of participants with account balances 2011-01-01 38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: ONE COMMUNITY HEALTH 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 60
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 52
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 9
Total of all active and inactive participants 2009-01-01 61
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 61
Number of participants with account balances 2009-01-01 37
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2022: ONE COMMUNITY HEALTH 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	401
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	254
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	201
Total of all active and inactive participants	2022-01-01	455
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	455
Number of participants with account balances	2022-01-01	441
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: ONE COMMUNITY HEALTH 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	363
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	306
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	93
Total of all active and inactive participants	2021-01-01	401
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	401
Number of participants with account balances	2021-01-01	390
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: ONE COMMUNITY HEALTH 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	352
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	243
Number of retired or separated participants receiving benefits	2020-01-01	21
Number of other retired or separated participants entitled to future benefits	2020-01-01	112
Total of all active and inactive participants	2020-01-01	376
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	376
Number of participants with account balances	2020-01-01	370
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	8
2019: ONE COMMUNITY HEALTH 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	285
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	244
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	99
Total of all active and inactive participants	2019-01-01	343
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	343
Number of participants with account balances	2019-01-01	337
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	10
2018: ONE COMMUNITY HEALTH 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	209
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	210
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	66
Total of all active and inactive participants	2018-01-01	276
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	276
Number of participants with account balances	2018-01-01	272
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	14
2017: ONE COMMUNITY HEALTH 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	189
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	171
Number of other retired or separated participants entitled to future benefits	2017-01-01	37
Total of all active and inactive participants	2017-01-01	208
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	208
Number of participants with account balances	2017-01-01	185
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	12
2016: ONE COMMUNITY HEALTH 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	153
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	163
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	26
Total of all active and inactive participants	2016-01-01	189
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	189
Number of participants with account balances	2016-01-01	162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	7
2015: ONE COMMUNITY HEALTH 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	134
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	19
Total of all active and inactive participants	2015-01-01	153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	153
Number of participants with account balances	2015-01-01	114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2012: ONE COMMUNITY HEALTH 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	78
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	79
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	9
Total of all active and inactive participants	2012-01-01	88
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	89
Number of participants with account balances	2012-01-01	80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	8
2011: ONE COMMUNITY HEALTH 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	83
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	73
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	73
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	73
Number of participants with account balances	2011-01-01	38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: ONE COMMUNITY HEALTH 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	60
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	52
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	9
Total of all active and inactive participants	2009-01-01	61
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	61
Number of participants with account balances	2009-01-01	37
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on ONE COMMUNITY HEALTH 401(K) PLAN

Measure	Date	Value
2022 : ONE COMMUNITY HEALTH 401(K) PLAN 2022 401k financial data
Unrealized appreciation/depreciation of real estate assets	2022-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2022-12-31	$0
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total transfer of assets to this plan	2022-12-31	$0
Total transfer of assets from this plan	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
Expenses. Interest paid	2022-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$962,587
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$1,425,848
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$1,419,323
Expenses. Certain deemed distributions of participant loans	2022-12-31	$0
Value of total corrective distributions	2022-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$2,334,017
Value of total assets at end of year	2022-12-31	$9,609,783
Value of total assets at beginning of year	2022-12-31	$10,073,044
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$6,525
Total income from rents	2022-12-31	$0
Total interest from all sources	2022-12-31	$6,408
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$427,225
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	$427,225
Assets. Real estate other than employer real property at end of year	2022-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2022-12-31	$0
Administrative expenses professional fees incurred	2022-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2022-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2022-12-31	$0
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	Yes
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$1,300,321
Participant contributions at end of year	2022-12-31	$154,671
Participant contributions at beginning of year	2022-12-31	$130,223
Participant contributions at end of year	2022-12-31	$38,497
Participant contributions at beginning of year	2022-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2022-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2022-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$254,019
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2022-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-12-31	$0
Assets. Loans (other than to participants) at end of year	2022-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2022-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$0
Other income not declared elsewhere	2022-12-31	$0
Administrative expenses (other) incurred	2022-12-31	$6,525
Liabilities. Value of operating payables at end of year	2022-12-31	$0
Liabilities. Value of operating payables at beginning of year	2022-12-31	$0
Total non interest bearing cash at end of year	2022-12-31	$0
Total non interest bearing cash at beginning of year	2022-12-31	$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	2022-12-31	No
Income. Non cash contributions	2022-12-31	$0
Value of net income/loss	2022-12-31	$-463,261
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$9,609,783
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$10,073,044
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
Assets. partnership/joint venture interests at end of year	2022-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2022-12-31	$0
Investment advisory and management fees	2022-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$9,147,500
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$9,861,212
Value of interest in pooled separate accounts at end of year	2022-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$0
Interest on participant loans	2022-12-31	$6,242
Income. Interest from loans (other than to participants)	2022-12-31	$0
Interest earned on other investments	2022-12-31	$18
Income. Interest from US Government securities	2022-12-31	$0
Income. Interest from corporate debt instruments	2022-12-31	$0
Value of interest in master investment trust accounts at end of year	2022-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2022-12-31	$0
Value of interest in common/collective trusts at end of year	2022-12-31	$0
Value of interest in common/collective trusts at beginning of year	2022-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$148,158
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	$148
Assets. Value of investments in 103.12 investment entities at end of year	2022-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2022-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$91,704
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$81,609
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$0
Asset value of US Government securities at end of year	2022-12-31	$0
Asset value of US Government securities at beginning of year	2022-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,805,063
Net investment gain/loss from pooled separate accounts	2022-12-31	$0
Net investment gain or loss from common/collective trusts	2022-12-31	$0
Net gain/loss from 103.12 investment entities	2022-12-31	$0
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
Assets. Invements in employer securities at end of year	2022-12-31	$0
Assets. Invements in employer securities at beginning of year	2022-12-31	$0
Assets. Value of employer real property at end of year	2022-12-31	$0
Assets. Value of employer real property at beginning of year	2022-12-31	$0
Contributions received in cash from employer	2022-12-31	$779,677
Employer contributions (assets) at end of year	2022-12-31	$29,253
Employer contributions (assets) at beginning of year	2022-12-31	$0
Income. Dividends from preferred stock	2022-12-31	$0
Income. Dividends from common stock	2022-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$1,419,323
Asset. Corporate debt instrument preferred debt at end of year	2022-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2022-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2022-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2022-12-31	$0
Contract administrator fees	2022-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2022-12-31	Yes
Assets. Corporate common stocks other than exployer securities at end of year	2022-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2022-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2022-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2022-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2022-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	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
Aggregate proceeds on sale of assets	2022-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2022-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2022-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2022-12-31	$0
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	FORVIS, LLP
Accountancy firm EIN	2022-12-31	440160260
2021 : ONE COMMUNITY HEALTH 401(K) PLAN 2021 401k financial data
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	$3,472,476
Total of all expenses incurred	2021-12-31	$1,129,457
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$1,106,965
Value of total corrective distributions	2021-12-31	$1,386
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$2,096,144
Value of total assets at end of year	2021-12-31	$10,073,044
Value of total assets at beginning of year	2021-12-31	$7,730,025
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$21,106
Total interest from all sources	2021-12-31	$8,325
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Administrative expenses professional fees incurred	2021-12-31	$18,767
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
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	$1,213,323
Participant contributions at end of year	2021-12-31	$130,223
Participant contributions at beginning of year	2021-12-31	$157,637
Participant contributions at end of year	2021-12-31	$0
Participant contributions at beginning of year	2021-12-31	$34,165
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$184,081
Liabilities. Value of operating payables at beginning of year	2021-12-31	$0
Total non interest bearing cash at end of year	2021-12-31	$0
Total non interest bearing cash at beginning of year	2021-12-31	$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	2021-12-31	No
Value of net income/loss	2021-12-31	$2,343,019
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$10,073,044
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$7,730,025
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	$2,339
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$9,861,212
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$7,469,638
Interest on participant loans	2021-12-31	$7,753
Interest earned on other investments	2021-12-31	$572
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$81,609
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$45,187
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$1,368,007
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	$698,740
Employer contributions (assets) at end of year	2021-12-31	$0
Employer contributions (assets) at beginning of year	2021-12-31	$23,398
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$1,106,965
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	FORVIS, LLP
Accountancy firm EIN	2021-12-31	440160260
2020 : ONE COMMUNITY HEALTH 401(K) PLAN 2020 401k financial data
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	$733
Total income from all sources (including contributions)	2020-12-31	$3,083,446
Total of all expenses incurred	2020-12-31	$729,108
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$707,115
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$2,154,722
Value of total assets at end of year	2020-12-31	$7,730,026
Value of total assets at beginning of year	2020-12-31	$5,376,421
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$21,993
Total interest from all sources	2020-12-31	$10,759
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Administrative expenses professional fees incurred	2020-12-31	$21,993
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	$1,190,312
Participant contributions at end of year	2020-12-31	$157,637
Participant contributions at beginning of year	2020-12-31	$205,647
Participant contributions at end of year	2020-12-31	$34,165
Participant contributions at beginning of year	2020-12-31	$296
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$263,412
Liabilities. Value of operating payables at end of year	2020-12-31	$0
Liabilities. Value of operating payables at beginning of year	2020-12-31	$733
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	$2,354,338
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$7,730,026
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$5,375,688
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	$7,469,639
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$5,132,079
Interest on participant loans	2020-12-31	$10,759
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$45,187
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$38,103
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$917,965
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	$700,998
Employer contributions (assets) at end of year	2020-12-31	$23,398
Employer contributions (assets) at beginning of year	2020-12-31	$296
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$707,115
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	BKD, LLP
Accountancy firm EIN	2020-12-31	440160260
2019 : ONE COMMUNITY HEALTH 401(K) PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$733
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$290
Total income from all sources (including contributions)	2019-12-31	$2,539,999
Total of all expenses incurred	2019-12-31	$987,535
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$974,170
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,675,720
Value of total assets at end of year	2019-12-31	$5,376,421
Value of total assets at beginning of year	2019-12-31	$3,823,514
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$13,365
Total interest from all sources	2019-12-31	$7,695
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Administrative expenses professional fees incurred	2019-12-31	$13,365
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$382,322
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	$825,101
Participant contributions at end of year	2019-12-31	$205,647
Participant contributions at beginning of year	2019-12-31	$103,413
Participant contributions at end of year	2019-12-31	$296
Participant contributions at beginning of year	2019-12-31	$142
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$283,882
Liabilities. Value of operating payables at end of year	2019-12-31	$733
Liabilities. Value of operating payables at beginning of year	2019-12-31	$290
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	$1,552,464
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$5,375,688
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,823,224
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	$5,132,079
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,684,153
Interest on participant loans	2019-12-31	$7,695
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$38,103
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$29,511
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$856,584
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	$566,737
Employer contributions (assets) at end of year	2019-12-31	$296
Employer contributions (assets) at beginning of year	2019-12-31	$6,295
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$974,170
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	MOSS ADAMS, LLP
Accountancy firm EIN	2019-12-31	910189318
2018 : ONE COMMUNITY HEALTH 401(K) PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$290
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$2,337
Total income from all sources (including contributions)	2018-12-31	$983,258
Total of all expenses incurred	2018-12-31	$469,727
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$455,616
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$1,221,282
Value of total assets at end of year	2018-12-31	$3,823,514
Value of total assets at beginning of year	2018-12-31	$3,312,030
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$14,111
Total interest from all sources	2018-12-31	$4,543
Administrative expenses professional fees incurred	2018-12-31	$14,111
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$330,969
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	$674,450
Participant contributions at end of year	2018-12-31	$103,413
Participant contributions at beginning of year	2018-12-31	$101,762
Participant contributions at end of year	2018-12-31	$142
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$95,621
Liabilities. Value of operating payables at end of year	2018-12-31	$290
Liabilities. Value of operating payables at beginning of year	2018-12-31	$2,337
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	$513,531
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$3,823,224
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$3,309,693
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$3,684,153
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$3,157,953
Interest on participant loans	2018-12-31	$4,543
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$29,511
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$36,599
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-242,567
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	$451,211
Employer contributions (assets) at end of year	2018-12-31	$6,295
Employer contributions (assets) at beginning of year	2018-12-31	$15,716
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$455,616
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	MOSS ADAMS, LLP
Accountancy firm EIN	2018-12-31	910189318
2017 : ONE COMMUNITY HEALTH 401(K) PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$2,337
Total income from all sources (including contributions)	2017-12-31	$1,156,468
Total of all expenses incurred	2017-12-31	$425,061
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$417,117
Value of total corrective distributions	2017-12-31	$1,158
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$695,803
Value of total assets at end of year	2017-12-31	$3,312,030
Value of total assets at beginning of year	2017-12-31	$2,578,286
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$6,786
Total interest from all sources	2017-12-31	$4,575
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$6,786
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$257,829
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	$476,792
Participant contributions at end of year	2017-12-31	$101,762
Participant contributions at beginning of year	2017-12-31	$81,466
Liabilities. Value of operating payables at end of year	2017-12-31	$2,337
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	$731,407
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$3,309,693
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,578,286
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$3,157,953
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$2,441,599
Income. Interest from loans (other than to participants)	2017-12-31	$3,909
Interest earned on other investments	2017-12-31	$666
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$36,599
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$36,923
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$456,090
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	$219,011
Employer contributions (assets) at end of year	2017-12-31	$15,716
Employer contributions (assets) at beginning of year	2017-12-31	$18,298
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$417,117
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	MOSS ADAMS, LLP
Accountancy firm EIN	2017-12-31	910189318
2016 : ONE COMMUNITY HEALTH 401(K) PLAN 2016 401k financial data
Total income from all sources (including contributions)	2016-12-31	$969,226
Total of all expenses incurred	2016-12-31	$257,214
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$230,907
Expenses. Certain deemed distributions of participant loans	2016-12-31	$8,354
Value of total corrective distributions	2016-12-31	$15,383
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$782,487
Value of total assets at end of year	2016-12-31	$2,578,286
Value of total assets at beginning of year	2016-12-31	$1,866,274
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$2,570
Total interest from all sources	2016-12-31	$3,758
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$118,697
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	$118,697
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	$369,559
Participant contributions at end of year	2016-12-31	$81,466
Participant contributions at beginning of year	2016-12-31	$79,831
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$206,600
Administrative expenses (other) incurred	2016-12-31	$2,570
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	$712,012
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,578,286
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,866,274
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$2,441,599
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,775,850
Interest on participant loans	2016-12-31	$3,758
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$36,923
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$10,593
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$64,284
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	$206,328
Employer contributions (assets) at end of year	2016-12-31	$18,298
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$230,907
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	MOSS ADAMS LLP
Accountancy firm EIN	2016-12-31	910189318
2015 : ONE COMMUNITY HEALTH 401(K) PLAN 2015 401k financial data
Total income from all sources (including contributions)	2015-12-31	$482,564
Total of all expenses incurred	2015-12-31	$437,741
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$436,850
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$517,906
Value of total assets at end of year	2015-12-31	$1,866,274
Value of total assets at beginning of year	2015-12-31	$1,821,451
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$891
Total interest from all sources	2015-12-31	$4,347
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$135,852
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$135,852
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$326,290
Participant contributions at end of year	2015-12-31	$79,831
Participant contributions at beginning of year	2015-12-31	$57,087
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$27,366
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$44,823
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,866,274
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,821,451
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$1,775,850
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$1,764,364
Income. Interest from loans (other than to participants)	2015-12-31	$3,027
Interest earned on other investments	2015-12-31	$1,320
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$10,593
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-175,541
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$164,250
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$436,850
Contract administrator fees	2015-12-31	$891
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	MOSS ADAMS LLP
Accountancy firm EIN	2015-12-31	910189318
2012 : ONE COMMUNITY HEALTH 401(K) PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$310,802
Expenses. Total of all expenses incurred	2012-12-31	$128,052
Benefits paid (including direct rollovers)	2012-12-31	$126,427
Total plan assets at end of year	2012-12-31	$1,043,281
Total plan assets at beginning of year	2012-12-31	$860,531
Value of fidelity bond covering the plan	2012-12-31	$1,000,000
Total contributions received or receivable from participants	2012-12-31	$125,260
Expenses. Other expenses not covered elsewhere	2012-12-31	$140
Contributions received from other sources (not participants or employers)	2012-12-31	$21,995
Other income received	2012-12-31	$91,483
Net income (gross income less expenses)	2012-12-31	$182,750
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,043,281
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$860,531
Assets. Value of participant loans	2012-12-31	$22,541
Total contributions received or receivable from employer(s)	2012-12-31	$72,064
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$1,485
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
2011 : ONE COMMUNITY HEALTH 401(K) PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$130,915
Expenses. Total of all expenses incurred	2011-12-31	$66,737
Benefits paid (including direct rollovers)	2011-12-31	$65,261
Total plan assets at end of year	2011-12-31	$860,531
Total plan assets at beginning of year	2011-12-31	$796,353
Value of fidelity bond covering the plan	2011-12-31	$1,000,000
Total contributions received or receivable from participants	2011-12-31	$100,353
Expenses. Other expenses not covered elsewhere	2011-12-31	$210
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-18,539
Net income (gross income less expenses)	2011-12-31	$64,178
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$860,531
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$796,353
Assets. Value of participant loans	2011-12-31	$27,158
Total contributions received or receivable from employer(s)	2011-12-31	$49,101
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$1,266
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
2010 : ONE COMMUNITY HEALTH 401(K) PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$224,402
Expenses. Total of all expenses incurred	2010-12-31	$25,567
Benefits paid (including direct rollovers)	2010-12-31	$25,319
Total plan assets at end of year	2010-12-31	$796,353
Total plan assets at beginning of year	2010-12-31	$597,518
Total contributions received or receivable from participants	2010-12-31	$95,248
Expenses. Other expenses not covered elsewhere	2010-12-31	$217
Contributions received from other sources (not participants or employers)	2010-12-31	$8,752
Other income received	2010-12-31	$67,016
Net income (gross income less expenses)	2010-12-31	$198,835
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$796,353
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$597,518
Assets. Value of participant loans	2010-12-31	$19,273
Total contributions received or receivable from employer(s)	2010-12-31	$53,386
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$31
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
2009 : ONE COMMUNITY HEALTH 401(K) PLAN 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for ONE COMMUNITY HEALTH 401(K) PLAN

2022: ONE COMMUNITY HEALTH 401(K) 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: ONE COMMUNITY HEALTH 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: ONE COMMUNITY HEALTH 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: ONE COMMUNITY HEALTH 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: ONE COMMUNITY HEALTH 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: ONE COMMUNITY HEALTH 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: ONE COMMUNITY HEALTH 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: ONE COMMUNITY HEALTH 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2012: ONE COMMUNITY HEALTH 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: ONE COMMUNITY HEALTH 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: ONE COMMUNITY HEALTH 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

818453

Policy instance

Insurance contract or identification number	818453
Number of Individuals Covered	0
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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 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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

335791-01

Policy instance

Insurance contract or identification number	335791-01
Number of Individuals Covered	22
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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 types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

335791-01

Policy instance

Insurance contract or identification number	335791-01
Number of Individuals Covered	16
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

335791-01

Policy instance

Insurance contract or identification number	335791-01
Number of Individuals Covered	8
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

335791-01

Policy instance

Insurance contract or identification number	335791-01
Number of Individuals Covered	9
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

335791-01

Policy instance

Insurance contract or identification number	335791-01
Number of Individuals Covered	7
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

335791-01

Policy instance

Insurance contract or identification number	335791-01
Number of Individuals Covered	6
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

335791-01

Policy instance

Insurance contract or identification number	335791-01
Number of Individuals Covered	2
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-025879

Policy instance

Insurance contract or identification number	GA-025879
Number of Individuals Covered	80
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,222
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,511
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO ADVRS INS AGCY

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-025879

Policy instance

Insurance contract or identification number	GA-025879
Number of Individuals Covered	38
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,474
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-025879

Policy instance

Insurance contract or identification number	GA-025879
Number of Individuals Covered	37
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,161
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CARES DBA ONE COMMUNITY HEALTH
Employer identification number (EIN):	680162903
NAIC Classification:	621498
NAIC Description:	All Other Outpatient Care Centers

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C1619150