401k Plan data: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER plan

TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 401k Plan overview

Plan Name	TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER
Plan identification number	002

TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met. Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.

401k Sponsoring company profile

JEFFERSON HOSPITAL ASSOCIATION, INC has sponsored the creation of one or more 401k plans.

Company Name: JEFFERSON HOSPITAL ASSOCIATION, INC

Employer identification number (EIN): 710329353

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about JEFFERSON HOSPITAL ASSOCIATION, INC

Jurisdiction of Incorporation: Arkansas Secretary of State

Incorporation Date:

Company Identification Number: 100027932

More information about JEFFERSON HOSPITAL ASSOCIATION, INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01 JEREMY JEFFERY 2023-10-13 JEREMY JEFFERY 2023-10-13
002 2021-01-01 JEREMY JEFFERY 2022-10-06 JEREMY JEFFERY 2022-10-06
002 2020-01-01 JEREMY JEFFERY 2021-10-15 JEREMY JEFFERY 2021-10-15
002 2019-01-01 JEREMY JEFFERY 2020-10-14
002 2018-01-01 BRYAN JACKSON 2019-10-15
002 2017-01-01 BRYAN JACKSON
002 2016-01-01 BRYAN JACKSON
002 2015-01-01 BRYAN JACKSON
002 2014-01-01 BRYAN JACKSON BRYAN JACKSON 2015-10-14
002 2013-01-01 BRYAN JACKSON BRYAN JACKSON 2014-10-15
002 2012-01-01 BRYAN JACKSON
002 2011-01-01 BRYAN JACKSON
002 2009-01-01 BROCK HOLMAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01	JEREMY JEFFERY	2023-10-13	JEREMY JEFFERY	2023-10-13
002	2021-01-01	JEREMY JEFFERY	2022-10-06	JEREMY JEFFERY	2022-10-06
002	2020-01-01	JEREMY JEFFERY	2021-10-15	JEREMY JEFFERY	2021-10-15
002	2019-01-01	JEREMY JEFFERY	2020-10-14
002	2018-01-01	BRYAN JACKSON	2019-10-15
002	2017-01-01	BRYAN JACKSON
002	2016-01-01	BRYAN JACKSON
002	2015-01-01	BRYAN JACKSON
002	2014-01-01	BRYAN JACKSON		BRYAN JACKSON	2015-10-14
002	2013-01-01	BRYAN JACKSON		BRYAN JACKSON	2014-10-15
002	2012-01-01	BRYAN JACKSON
002	2011-01-01	BRYAN JACKSON
002	2009-01-01	BROCK HOLMAN

Plan Statistics for TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER

401k plan membership statisitcs for TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER

Measure Date Value
2022: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2022 401k membership
Total participants, beginning-of-year 2022-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 119
Number of retired or separated participants receiving benefits 2022-01-01 4
Number of other retired or separated participants entitled to future benefits 2022-01-01 33
Total of all active and inactive participants 2022-01-01 156
Total participants 2022-01-01 156
Number of participants with account balances 2022-01-01 115
2021: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2021 401k membership
Total participants, beginning-of-year 2021-01-01 153
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 115
Number of other retired or separated participants entitled to future benefits 2021-01-01 37
Total of all active and inactive participants 2021-01-01 152
Total participants 2021-01-01 152
Number of participants with account balances 2021-01-01 117
2020: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2020 401k membership
Total participants, beginning-of-year 2020-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 111
Number of other retired or separated participants entitled to future benefits 2020-01-01 42
Total of all active and inactive participants 2020-01-01 153
Total participants 2020-01-01 153
Number of participants with account balances 2020-01-01 121
2019: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2019 401k membership
Total participants, beginning-of-year 2019-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 114
Number of other retired or separated participants entitled to future benefits 2019-01-01 41
Total of all active and inactive participants 2019-01-01 155
Total participants 2019-01-01 155
Number of participants with account balances 2019-01-01 126
2018: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2018 401k membership
Total participants, beginning-of-year 2018-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 121
Number of other retired or separated participants entitled to future benefits 2018-01-01 43
Total of all active and inactive participants 2018-01-01 164
Total participants 2018-01-01 164
Number of participants with account balances 2018-01-01 138
2017: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2017 401k membership
Total participants, beginning-of-year 2017-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 120
Number of other retired or separated participants entitled to future benefits 2017-01-01 43
Total of all active and inactive participants 2017-01-01 163
Total participants 2017-01-01 163
Number of participants with account balances 2017-01-01 138
2016: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2016 401k membership
Total participants, beginning-of-year 2016-01-01 159
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 122
Number of other retired or separated participants entitled to future benefits 2016-01-01 41
Total of all active and inactive participants 2016-01-01 163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 1
Total participants 2016-01-01 164
Number of participants with account balances 2016-01-01 139
2015: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2015 401k membership
Total participants, beginning-of-year 2015-01-01 159
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 115
Number of retired or separated participants receiving benefits 2015-01-01 44
Total of all active and inactive participants 2015-01-01 159
Total participants 2015-01-01 159
Number of participants with account balances 2015-01-01 159
2014: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2014 401k membership
Total participants, beginning-of-year 2014-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 125
Number of retired or separated participants receiving benefits 2014-01-01 34
Total of all active and inactive participants 2014-01-01 159
Total participants 2014-01-01 159
2013: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2013 401k membership
Total participants, beginning-of-year 2013-01-01 159
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 122
Number of other retired or separated participants entitled to future benefits 2013-01-01 32
Total of all active and inactive participants 2013-01-01 154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 155
Number of participants with account balances 2013-01-01 155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2012 401k membership
Total participants, beginning-of-year 2012-01-01 159
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 126
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 32
Total of all active and inactive participants 2012-01-01 158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 159
Number of participants with account balances 2012-01-01 159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2011 401k membership
Total participants, beginning-of-year 2011-01-01 162
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 122
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 36
Total of all active and inactive participants 2011-01-01 158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 159
Number of participants with account balances 2011-01-01 159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2009 401k membership
Total participants, beginning-of-year 2009-01-01 182
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 126
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 37
Total of all active and inactive participants 2009-01-01 163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 164
Number of participants with account balances 2009-01-01 163
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2022: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2022 401k membership
Total participants, beginning-of-year	2022-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	119
Number of retired or separated participants receiving benefits	2022-01-01	4
Number of other retired or separated participants entitled to future benefits	2022-01-01	33
Total of all active and inactive participants	2022-01-01	156
Total participants	2022-01-01	156
Number of participants with account balances	2022-01-01	115
2021: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2021 401k membership
Total participants, beginning-of-year	2021-01-01	153
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	115
Number of other retired or separated participants entitled to future benefits	2021-01-01	37
Total of all active and inactive participants	2021-01-01	152
Total participants	2021-01-01	152
Number of participants with account balances	2021-01-01	117
2020: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2020 401k membership
Total participants, beginning-of-year	2020-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	111
Number of other retired or separated participants entitled to future benefits	2020-01-01	42
Total of all active and inactive participants	2020-01-01	153
Total participants	2020-01-01	153
Number of participants with account balances	2020-01-01	121
2019: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2019 401k membership
Total participants, beginning-of-year	2019-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	114
Number of other retired or separated participants entitled to future benefits	2019-01-01	41
Total of all active and inactive participants	2019-01-01	155
Total participants	2019-01-01	155
Number of participants with account balances	2019-01-01	126
2018: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2018 401k membership
Total participants, beginning-of-year	2018-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	121
Number of other retired or separated participants entitled to future benefits	2018-01-01	43
Total of all active and inactive participants	2018-01-01	164
Total participants	2018-01-01	164
Number of participants with account balances	2018-01-01	138
2017: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2017 401k membership
Total participants, beginning-of-year	2017-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	120
Number of other retired or separated participants entitled to future benefits	2017-01-01	43
Total of all active and inactive participants	2017-01-01	163
Total participants	2017-01-01	163
Number of participants with account balances	2017-01-01	138
2016: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2016 401k membership
Total participants, beginning-of-year	2016-01-01	159
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	122
Number of other retired or separated participants entitled to future benefits	2016-01-01	41
Total of all active and inactive participants	2016-01-01	163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	1
Total participants	2016-01-01	164
Number of participants with account balances	2016-01-01	139
2015: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2015 401k membership
Total participants, beginning-of-year	2015-01-01	159
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	115
Number of retired or separated participants receiving benefits	2015-01-01	44
Total of all active and inactive participants	2015-01-01	159
Total participants	2015-01-01	159
Number of participants with account balances	2015-01-01	159
2014: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2014 401k membership
Total participants, beginning-of-year	2014-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	125
Number of retired or separated participants receiving benefits	2014-01-01	34
Total of all active and inactive participants	2014-01-01	159
Total participants	2014-01-01	159
2013: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2013 401k membership
Total participants, beginning-of-year	2013-01-01	159
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	122
Number of other retired or separated participants entitled to future benefits	2013-01-01	32
Total of all active and inactive participants	2013-01-01	154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	155
Number of participants with account balances	2013-01-01	155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2012 401k membership
Total participants, beginning-of-year	2012-01-01	159
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	126
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	32
Total of all active and inactive participants	2012-01-01	158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	159
Number of participants with account balances	2012-01-01	159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2011 401k membership
Total participants, beginning-of-year	2011-01-01	162
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	122
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	36
Total of all active and inactive participants	2011-01-01	158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	159
Number of participants with account balances	2011-01-01	159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2009 401k membership
Total participants, beginning-of-year	2009-01-01	182
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	126
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	37
Total of all active and inactive participants	2009-01-01	163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	164
Number of participants with account balances	2009-01-01	163
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER

Measure	Date	Value
2022 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2022 401k financial data
Total income from all sources (including contributions)	2022-12-31	$-543,006
Total of all expenses incurred	2022-12-31	$105,171
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$104,404
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$151,984
Value of total assets at end of year	2022-12-31	$4,365,364
Value of total assets at beginning of year	2022-12-31	$5,013,541
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$767
Total interest from all sources	2022-12-31	$29,301
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	$151,984
Administrative expenses (other) incurred	2022-12-31	$767
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	$-648,177
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$4,365,364
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$5,013,541
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 pooled separate accounts at end of year	2022-12-31	$3,204,556
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$3,878,594
Interest earned on other investments	2022-12-31	$29,301
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$1,160,808
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$1,134,947
Net investment gain/loss from pooled separate accounts	2022-12-31	$-724,291
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$104,404
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	FORVIS, LLP
Accountancy firm EIN	2022-12-31	440160260
2021 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2021 401k financial data
Total income from all sources (including contributions)	2021-12-31	$800,313
Total of all expenses incurred	2021-12-31	$735,286
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$734,035
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$149,236
Value of total assets at end of year	2021-12-31	$5,013,541
Value of total assets at beginning of year	2021-12-31	$4,948,514
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$1,251
Total interest from all sources	2021-12-31	$28,294
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	$149,236
Administrative expenses (other) incurred	2021-12-31	$1,251
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	$65,027
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$5,013,541
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$4,948,514
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 pooled separate accounts at end of year	2021-12-31	$3,878,594
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$3,693,912
Interest earned on other investments	2021-12-31	$28,294
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$1,134,947
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$1,254,602
Net investment gain/loss from pooled separate accounts	2021-12-31	$622,783
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	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$734,035
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 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$691,506
Total of all expenses incurred	2020-12-31	$731,013
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$729,613
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$160,950
Value of total assets at end of year	2020-12-31	$4,948,514
Value of total assets at beginning of year	2020-12-31	$4,988,021
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$1,400
Total interest from all sources	2020-12-31	$29,317
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
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$160,950
Administrative expenses (other) incurred	2020-12-31	$1,400
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$-39,507
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$4,948,514
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$4,988,021
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 pooled separate accounts at end of year	2020-12-31	$3,693,912
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$3,908,436
Interest earned on other investments	2020-12-31	$29,317
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$1,254,602
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$1,079,585
Net investment gain/loss from pooled separate accounts	2020-12-31	$501,239
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$729,613
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 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$996,764
Total income from all sources (including contributions)	2019-12-31	$996,764
Total of all expenses incurred	2019-12-31	$376,556
Total of all expenses incurred	2019-12-31	$376,556
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$375,055
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$192,829
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$192,829
Value of total assets at end of year	2019-12-31	$4,988,021
Value of total assets at end of year	2019-12-31	$4,988,021
Value of total assets at beginning of year	2019-12-31	$4,367,813
Value of total assets at beginning of year	2019-12-31	$4,367,813
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,501
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,501
Total interest from all sources	2019-12-31	$31,832
Total interest from all sources	2019-12-31	$31,832
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
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
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
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$192,829
Contributions received from participants	2019-12-31	$192,829
Administrative expenses (other) incurred	2019-12-31	$1,501
Administrative expenses (other) incurred	2019-12-31	$1,501
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	$620,208
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$4,988,021
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$4,988,021
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,367,813
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,367,813
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
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 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 pooled separate accounts at end of year	2019-12-31	$3,908,436
Value of interest in pooled separate accounts at end of year	2019-12-31	$3,908,436
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$3,027,264
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$3,027,264
Interest earned on other investments	2019-12-31	$31,832
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,079,585
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,079,585
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,340,549
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,340,549
Net investment gain/loss from pooled separate accounts	2019-12-31	$772,103
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
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
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
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$375,055
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$375,055
Did the plan have assets held for investment	2019-12-31	Yes
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
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
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
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
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	BKD, LLP
Accountancy firm name	2019-12-31	BKD, LLP
Accountancy firm EIN	2019-12-31	440160260
Accountancy firm EIN	2019-12-31	440160260
2018 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$7,589
Total of all expenses incurred	2018-12-31	$327,925
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$326,386
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$205,051
Value of total assets at end of year	2018-12-31	$4,367,813
Value of total assets at beginning of year	2018-12-31	$4,688,149
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$1,539
Total interest from all sources	2018-12-31	$34,216
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$205,051
Administrative expenses (other) incurred	2018-12-31	$1,539
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	$-320,336
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$4,367,813
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$4,688,149
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 pooled separate accounts at end of year	2018-12-31	$3,027,264
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$3,493,270
Interest earned on other investments	2018-12-31	$34,216
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$1,340,549
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$1,194,879
Net investment gain/loss from pooled separate accounts	2018-12-31	$-231,678
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$326,386
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	BKD, LLP
Accountancy firm EIN	2018-12-31	440160260
2017 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$759,748
Total of all expenses incurred	2017-12-31	$172,235
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$170,641
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$252,532
Value of total assets at end of year	2017-12-31	$4,688,149
Value of total assets at beginning of year	2017-12-31	$4,100,636
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$1,594
Total interest from all sources	2017-12-31	$32,447
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2017-12-31	0
Minimum employer required contribution for this plan year	2017-12-31	$0
Amount contributed by the employer to the plan for this plan year	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	$225,329
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$27,203
Administrative expenses (other) incurred	2017-12-31	$1,594
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	$587,513
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$4,688,149
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$4,100,636
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 pooled separate accounts at end of year	2017-12-31	$3,493,270
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$2,830,350
Interest earned on other investments	2017-12-31	$32,447
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$1,194,879
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$1,270,286
Net investment gain/loss from pooled separate accounts	2017-12-31	$474,769
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$170,641
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	BKD, LLP
Accountancy firm EIN	2017-12-31	440160260
2016 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2016-12-31	$31,975
Total unrealized appreciation/depreciation of assets	2016-12-31	$31,975
Total income from all sources (including contributions)	2016-12-31	$534,497
Total of all expenses incurred	2016-12-31	$1,251,777
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$1,250,144
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$254,964
Value of total assets at end of year	2016-12-31	$4,100,636
Value of total assets at beginning of year	2016-12-31	$4,817,916
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$1,633
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2016-12-31	0
Funding deficiency by the employer to the plan for this plan year	2016-12-31	$0
Minimum employer required contribution for this plan year	2016-12-31	$0
Amount contributed by the employer to the plan for this plan year	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	$254,964
Administrative expenses (other) incurred	2016-12-31	$1,633
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	$-717,280
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$4,100,636
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$4,817,916
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 pooled separate accounts at end of year	2016-12-31	$2,830,350
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$3,673,079
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$1,270,286
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$1,144,837
Net investment gain/loss from pooled separate accounts	2016-12-31	$247,558
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$1,250,144
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	BKD, LLP
Accountancy firm EIN	2016-12-31	440160260
2015 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2015 401k financial data
Total income from all sources (including contributions)	2015-12-31	$407,076
Total of all expenses incurred	2015-12-31	$220,912
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$219,129
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$349,047
Value of total assets at end of year	2015-12-31	$4,817,916
Value of total assets at beginning of year	2015-12-31	$4,631,752
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$1,783
Total interest from all sources	2015-12-31	$30,792
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2015-12-31	0
Minimum employer required contribution for this plan year	2015-12-31	$0
Amount contributed by the employer to the plan for this plan year	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	$309,147
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$39,900
Administrative expenses (other) incurred	2015-12-31	$1,783
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	$186,164
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$4,817,916
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$4,631,752
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	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$3,503,147
Value of interest in pooled separate accounts at end of year	2015-12-31	$3,673,079
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$0
Interest earned on other investments	2015-12-31	$30,792
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$1,144,837
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$1,128,605
Net investment gain/loss from pooled separate accounts	2015-12-31	$27,237
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$219,129
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	BKD, LLP
Accountancy firm EIN	2015-12-31	440160260
2014 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2014 401k financial data
Total income from all sources (including contributions)	2014-12-31	$599,977
Total of all expenses incurred	2014-12-31	$199,075
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$197,255
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$296,205
Value of total assets at end of year	2014-12-31	$4,631,752
Value of total assets at beginning of year	2014-12-31	$4,230,850
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$1,820
Total interest from all sources	2014-12-31	$29,422
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$400,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2014-12-31	0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$296,205
Administrative expenses (other) incurred	2014-12-31	$1,820
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$400,902
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$4,631,752
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$4,230,850
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$3,503,147
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$3,179,597
Interest earned on other investments	2014-12-31	$29,422
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$1,128,605
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$1,051,253
Net investment gain/loss from pooled separate accounts	2014-12-31	$274,350
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$197,255
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	BKD, LLP
Accountancy firm EIN	2014-12-31	440160260
2013 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$941,959
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$262,428
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$260,608
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$269,029
Value of total assets at end of year	2013-12-31	$4,230,850
Value of total assets at beginning of year	2013-12-31	$3,551,319
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$1,820
Total interest from all sources	2013-12-31	$28,747
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$300,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2013-12-31	0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$269,029
Administrative expenses (other) incurred	2013-12-31	$1,820
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$679,531
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$4,230,850
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$3,551,319
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$3,179,597
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$2,447,773
Interest earned on other investments	2013-12-31	$28,747
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$1,051,253
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$1,103,546
Net investment gain/loss from pooled separate accounts	2013-12-31	$644,183
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$260,608
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	BKD, LLP
Accountancy firm EIN	2013-12-31	440160260
2012 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$602,463
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$414,928
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$412,931
Expenses. Certain deemed distributions of participant loans	2012-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$274,820
Value of total assets at end of year	2012-12-31	$3,551,319
Value of total assets at beginning of year	2012-12-31	$3,358,611
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$1,997
Total interest from all sources	2012-12-31	$28,507
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$200,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$269,736
Participant contributions at end of year	2012-12-31	$69,095
Participant contributions at beginning of year	2012-12-31	$30,166
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$5,084
Other income not declared elsewhere	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$1,997
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$187,535
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$3,551,319
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$3,358,611
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$2,447,773
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$2,309,470
Interest on participant loans	2012-12-31	$0
Interest earned on other investments	2012-12-31	$28,507
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$1,034,451
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$1,018,975
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$0
Net investment gain/loss from pooled separate accounts	2012-12-31	$299,136
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$412,931
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	CLIFTONLARSONALLEN
Accountancy firm EIN	2012-12-31	410746749
2011 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$219,939
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$289,181
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$287,195
Expenses. Certain deemed distributions of participant loans	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$235,880
Value of total assets at end of year	2011-12-31	$3,358,611
Value of total assets at beginning of year	2011-12-31	$3,427,853
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,986
Total interest from all sources	2011-12-31	$24,934
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$200,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$235,880
Participant contributions at end of year	2011-12-31	$30,166
Participant contributions at beginning of year	2011-12-31	$35,462
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$0
Other income not declared elsewhere	2011-12-31	$0
Administrative expenses (other) incurred	2011-12-31	$1,986
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-69,242
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$3,358,611
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$3,427,853
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$2,309,470
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$2,765,099
Interest on participant loans	2011-12-31	$0
Interest earned on other investments	2011-12-31	$24,934
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$1,018,975
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$627,292
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$0
Net investment gain/loss from pooled separate accounts	2011-12-31	$-40,875
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$287,195
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2011-12-31	410746749
2010 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$643,153
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$243,216
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$241,131
Expenses. Certain deemed distributions of participant loans	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$248,224
Value of total assets at end of year	2010-12-31	$3,427,853
Value of total assets at beginning of year	2010-12-31	$3,027,916
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$2,085
Total interest from all sources	2010-12-31	$17,608
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$200,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$248,224
Participant contributions at end of year	2010-12-31	$35,462
Participant contributions at beginning of year	2010-12-31	$19,661
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$0
Administrative expenses (other) incurred	2010-12-31	$2,085
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$399,937
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$3,427,853
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$3,027,916
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$2,765,099
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$2,513,378
Interest on participant loans	2010-12-31	$0
Interest earned on other investments	2010-12-31	$17,608
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$627,292
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$494,877
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$0
Net investment gain/loss from pooled separate accounts	2010-12-31	$377,321
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$241,131
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	LARSONALLEN LLP
Accountancy firm EIN	2010-12-31	410746749
2009 : TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER

2022: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 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 benefit arrangement – Insurance	Yes
2020: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 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 benefit arrangement – Insurance	Yes
2018: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 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 benefit arrangement – Insurance	Yes
2011: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 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 benefit arrangement – Insurance	Yes
2009: TAX DEFERRED ANNUITY PLAN OF JEFFERSON REGIONAL MEDICAL CENTER 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

008134

Policy instance

Insurance contract or identification number	008134
Number of Individuals Covered	156
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of fees paid to insurance company	USD $518
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	518
Additional information about fees paid to insurance broker	INCENTIVE COMPENSATION
Insurance broker organization code?	3

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

008134-F

Policy instance

Insurance contract or identification number	008134-F
Number of Individuals Covered	152
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $200
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	200
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

008134-F

Policy instance

Insurance contract or identification number	008134-F
Number of Individuals Covered	153
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $200
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	200
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

008134-F

Policy instance

Insurance contract or identification number	008134-F
Number of Individuals Covered	155
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $802
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	802
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

008134-F

Policy instance

Insurance contract or identification number	008134-F
Number of Individuals Covered	164
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $263
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	263
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

008134-F

Policy instance

Insurance contract or identification number	008134-F
Number of Individuals Covered	163
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $396
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	396
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	NASHVILLE REGIONAL OFFICE

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

008134-F

Policy instance

Insurance contract or identification number	008134-F
Number of Individuals Covered	159
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of fees paid to insurance company	USD $36
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	36
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	NASHVILLE REGIONAL OFFICE

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

008134-F

Policy instance

Insurance contract or identification number	008134-F
Number of Individuals Covered	159
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of fees paid to insurance company	USD $433
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	433
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	NASHVILLE REGIONAL OFFICE

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

008134-F

Policy instance

Insurance contract or identification number	008134-F
Number of Individuals Covered	155
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of fees paid to insurance company	USD $397
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Amount paid for insurance broker fees	397
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	NASHVILLE REGIONAL OFFICE

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

008134F

Policy instance

Insurance contract or identification number	008134F
Number of Individuals Covered	159
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $666
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	200
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	JAY MCFADDEN

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

008134F

Policy instance

Insurance contract or identification number	008134F
Number of Individuals Covered	159
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $648
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

008134F

Policy instance

Insurance contract or identification number	008134F
Number of Individuals Covered	162
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $667
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	JEFFERSON HOSPITAL ASSOCIATION, INC
Employer identification number (EIN):	710329353
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Arkansas Secretary of State
Incorporation Date:
Company Identification Number:	100027932