401k Plan data: PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL plan

PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 401k Plan overview

Plan Name	PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL
Plan identification number	001

PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
Plan covered by PBGC that was terminated and closed out for PBGC purposes - Before the end of the plan year (or a prior plan year), (1) the plan terminated in a standard (or distress) termination and completed the distribution of plan assets in satisfaction of all benefit liabilities (or all ERISA Title IV benefits for distress termination); or (2) a trustee was appointed for a terminated plan pursuant to ERISA section 4042.
Frozen Plan - As of the last day of the plan year, the plan provides that no participant will get any new benefit accrual (whether because of service or compensation).

401k Sponsoring company profile

MBH HOSPITAL, LLC DBA HIGHLAND HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: MBH HOSPITAL, LLC DBA HIGHLAND HOSPITAL

Employer identification number (EIN): 822364266

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-01-01 AMY STRICKER 2021-04-06 AMY STRICKER 2021-04-06
001 2019-01-01 AMY STRICKER 2020-10-13 AMY STRICKER 2020-10-13
001 2018-01-01 CHRIS MILLER 2019-10-14 CHRIS MILLER 2019-10-14
001 2017-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2020-01-01	AMY STRICKER	2021-04-06	AMY STRICKER	2021-04-06
001	2019-01-01	AMY STRICKER	2020-10-13	AMY STRICKER	2020-10-13
001	2018-01-01	CHRIS MILLER	2019-10-14	CHRIS MILLER	2019-10-14
001	2017-01-01

Plan Statistics for PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL

401k plan membership statisitcs for PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL

Measure Date Value
2020: PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2020 401k membership
Market value of plan assets 2020-06-30 4,367,320
Acturial value of plan assets 2020-06-30 4,188,600
Funding target for retired participants and beneficiaries receiving payment 2020-06-30 3,283,370
Number of terminated vested participants 2020-06-30 57
Fundng target for terminated vested participants 2020-06-30 1,708,099
Active participant vested funding target 2020-06-30 760,744
Number of active participants 2020-06-30 17
Total funding liabilities for active participants 2020-06-30 760,744
Total participant count 2020-06-30 148
Total funding target for all participants 2020-06-30 5,752,213
Balance at beginning of prior year after applicable adjustments 2020-06-30 0
Prefunding balance at beginning of prior year after applicable adjustments 2020-06-30 0
Carryover balanced portion elected for use to offset prior years funding requirement 2020-06-30 0
Prefunding balanced used to offset prior years funding requirement 2020-06-30 0
Amount remaining of carryover balance 2020-06-30 0
Amount remaining of prefunding balance 2020-06-30 0
Present value of excess contributions 2020-06-30 0
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2020-06-30 0
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2020-06-30 0
Reductions in caryover balances due to elections or deemed elections 2020-06-30 0
Reductions in prefunding balances due to elections or deemed elections 2020-06-30 0
Balance of carryovers at beginning of current year 2020-06-30 0
Balance of prefunding at beginning of current year 2020-06-30 0
Contributions allocated toward unpaid minimum require contributions from prior years 2020-06-30 0
Contributions made to avoid restrictions adjusted to valuation date 2020-06-30 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2020-06-30 0
Liquidity shortfalls end of Q1 2020-06-30 0
Liquidity shortfalls end of Q2 2020-06-30 0
Liquidity shortfalls end of Q3 2020-06-30 0
Liquidity shortfalls end of Q4 2020-06-30 0
Unpaid minimum required contributions for all prior years 2020-06-30 480,251
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2020-06-30 0
Remaining amount of unpaid minimum required contributions 2020-06-30 480,251
Minimum required contributions for current year target normal cost 2020-06-30 64,378
Net shortfall amortization installment of oustanding balance 2020-06-30 781,807
Waiver amortization installment 2020-06-30 0
Total funding amount beforereflecting carryover/prefunding balances 2020-06-30 244,265
Additional cash requirement 2020-06-30 244,265
Contributions allocatedtoward minimum required contributions for current year 2020-06-30 0
Unpaid minimum required contributions for current year 2020-06-30 244,265
Unpaid minimum required contributions for all years 2020-06-30 724,516
Total participants, beginning-of-year 2020-01-01 148
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 15
Number of retired or separated participants receiving benefits 2020-01-01 71
Number of other retired or separated participants entitled to future benefits 2020-01-01 59
Total of all active and inactive participants 2020-01-01 145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 5
Total participants 2020-01-01 150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2019 401k membership
Market value of plan assets 2019-12-31 4,181,345
Acturial value of plan assets 2019-12-31 4,467,756
Funding target for retired participants and beneficiaries receiving payment 2019-12-31 3,076,764
Number of terminated vested participants 2019-12-31 56
Fundng target for terminated vested participants 2019-12-31 1,492,320
Active participant vested funding target 2019-12-31 1,222,912
Number of active participants 2019-12-31 25
Total funding liabilities for active participants 2019-12-31 1,222,912
Total participant count 2019-12-31 153
Total funding target for all participants 2019-12-31 5,791,996
Balance at beginning of prior year after applicable adjustments 2019-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2019-12-31 21,849
Carryover balanced portion elected for use to offset prior years funding requirement 2019-12-31 0
Prefunding balanced used to offset prior years funding requirement 2019-12-31 21,849
Amount remaining of carryover balance 2019-12-31 0
Amount remaining of prefunding balance 2019-12-31 0
Present value of excess contributions 2019-12-31 0
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2019-12-31 0
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2019-12-31 0
Reductions in caryover balances due to elections or deemed elections 2019-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2019-12-31 0
Balance of carryovers at beginning of current year 2019-12-31 0
Balance of prefunding at beginning of current year 2019-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2019-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2019-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2019-12-31 0
Liquidity shortfalls end of Q1 2019-12-31 0
Liquidity shortfalls end of Q2 2019-12-31 0
Liquidity shortfalls end of Q3 2019-12-31 0
Liquidity shortfalls end of Q4 2019-12-31 0
Unpaid minimum required contributions for all prior years 2019-12-31 102,086
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2019-12-31 0
Remaining amount of unpaid minimum required contributions 2019-12-31 102,086
Minimum required contributions for current year target normal cost 2019-12-31 73,650
Net shortfall amortization installment of oustanding balance 2019-12-31 1,324,240
Waiver amortization installment 2019-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2019-12-31 378,165
Carryover balance elected to use to offset funding requirement 2019-12-31 0
Prefunding balance elected to use to offset funding requirement 2019-12-31 0
Additional cash requirement 2019-12-31 378,165
Contributions allocatedtoward minimum required contributions for current year 2019-12-31 0
Unpaid minimum required contributions for current year 2019-12-31 378,165
Unpaid minimum required contributions for all years 2019-12-31 480,251
Total participants, beginning-of-year 2019-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 17
Number of retired or separated participants receiving benefits 2019-01-01 68
Number of other retired or separated participants entitled to future benefits 2019-01-01 57
Total of all active and inactive participants 2019-01-01 142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 6
Total participants 2019-01-01 148
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2018 401k membership
Market value of plan assets 2018-12-31 5,118,952
Acturial value of plan assets 2018-12-31 5,104,783
Funding target for retired participants and beneficiaries receiving payment 2018-12-31 2,967,001
Number of terminated vested participants 2018-12-31 75
Fundng target for terminated vested participants 2018-12-31 1,788,629
Active participant vested funding target 2018-12-31 1,469,917
Number of active participants 2018-12-31 29
Total funding liabilities for active participants 2018-12-31 1,469,917
Total participant count 2018-12-31 176
Total funding target for all participants 2018-12-31 6,225,547
Balance at beginning of prior year after applicable adjustments 2018-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2018-12-31 148
Carryover balanced portion elected for use to offset prior years funding requirement 2018-12-31 0
Prefunding balanced used to offset prior years funding requirement 2018-12-31 0
Amount remaining of carryover balance 2018-12-31 0
Amount remaining of prefunding balance 2018-12-31 148
Present value of excess contributions 2018-12-31 20,470
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2018-12-31 21,690
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2018-12-31 21,690
Reductions in caryover balances due to elections or deemed elections 2018-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2018-12-31 0
Balance of carryovers at beginning of current year 2018-12-31 0
Balance of prefunding at beginning of current year 2018-12-31 21,849
Total employer contributions 2018-12-31 68,790
Total employee contributions 2018-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2018-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2018-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2018-12-31 67,245
Liquidity shortfalls end of Q1 2018-12-31 0
Liquidity shortfalls end of Q2 2018-12-31 0
Liquidity shortfalls end of Q3 2018-12-31 0
Liquidity shortfalls end of Q4 2018-12-31 0
Unpaid minimum required contributions for all prior years 2018-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2018-12-31 0
Remaining amount of unpaid minimum required contributions 2018-12-31 0
Minimum required contributions for current year target normal cost 2018-12-31 18,090
Net shortfall amortization installment of oustanding balance 2018-12-31 1,142,613
Waiver amortization installment 2018-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2018-12-31 190,104
Carryover balance elected to use to offset funding requirement 2018-12-31 0
Prefunding balance elected to use to offset funding requirement 2018-12-31 20,773
Additional cash requirement 2018-12-31 169,331
Contributions allocatedtoward minimum required contributions for current year 2018-12-31 67,245
Unpaid minimum required contributions for current year 2018-12-31 102,086
Unpaid minimum required contributions for all years 2018-12-31 102,086
Total participants, beginning-of-year 2018-01-01 176
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 24
Number of retired or separated participants receiving benefits 2018-01-01 67
Number of other retired or separated participants entitled to future benefits 2018-01-01 56
Total of all active and inactive participants 2018-01-01 147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 5
Total participants 2018-01-01 152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2017 401k membership
Market value of plan assets 2017-12-31 4,886,667
Acturial value of plan assets 2017-12-31 5,050,696
Funding target for retired participants and beneficiaries receiving payment 2017-12-31 2,603,463
Number of terminated vested participants 2017-12-31 89
Fundng target for terminated vested participants 2017-12-31 1,988,072
Active participant vested funding target 2017-12-31 1,368,335
Number of active participants 2017-12-31 30
Total funding liabilities for active participants 2017-12-31 1,368,335
Total participant count 2017-12-31 192
Total funding target for all participants 2017-12-31 5,959,870
Balance at beginning of prior year after applicable adjustments 2017-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2017-12-31 143
Carryover balanced portion elected for use to offset prior years funding requirement 2017-12-31 0
Prefunding balanced used to offset prior years funding requirement 2017-12-31 0
Amount remaining of carryover balance 2017-12-31 0
Amount remaining of prefunding balance 2017-12-31 143
Present value of excess contributions 2017-12-31 114
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2017-12-31 121
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2017-12-31 0
Reductions in caryover balances due to elections or deemed elections 2017-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2017-12-31 0
Balance of carryovers at beginning of current year 2017-12-31 0
Balance of prefunding at beginning of current year 2017-12-31 148
Total employer contributions 2017-12-31 215,958
Total employee contributions 2017-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2017-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2017-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2017-12-31 209,346
Liquidity shortfalls end of Q1 2017-12-31 0
Liquidity shortfalls end of Q2 2017-12-31 0
Liquidity shortfalls end of Q3 2017-12-31 0
Liquidity shortfalls end of Q4 2017-12-31 0
Unpaid minimum required contributions for all prior years 2017-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2017-12-31 0
Remaining amount of unpaid minimum required contributions 2017-12-31 0
Minimum required contributions for current year target normal cost 2017-12-31 8,693
Net shortfall amortization installment of oustanding balance 2017-12-31 909,322
Waiver amortization installment 2017-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2017-12-31 188,876
Additional cash requirement 2017-12-31 188,876
Contributions allocatedtoward minimum required contributions for current year 2017-12-31 209,346
Unpaid minimum required contributions for current year 2017-12-31 0
Unpaid minimum required contributions for all years 2017-12-31 0
Total participants, beginning-of-year 2017-01-01 192
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 28
Number of retired or separated participants receiving benefits 2017-01-01 68
Number of other retired or separated participants entitled to future benefits 2017-01-01 75
Total of all active and inactive participants 2017-01-01 171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 5
Total participants 2017-01-01 176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0

Measure	Date	Value
2020: PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2020 401k membership
Market value of plan assets	2020-06-30	4,367,320
Acturial value of plan assets	2020-06-30	4,188,600
Funding target for retired participants and beneficiaries receiving payment	2020-06-30	3,283,370
Number of terminated vested participants	2020-06-30	57
Fundng target for terminated vested participants	2020-06-30	1,708,099
Active participant vested funding target	2020-06-30	760,744
Number of active participants	2020-06-30	17
Total funding liabilities for active participants	2020-06-30	760,744
Total participant count	2020-06-30	148
Total funding target for all participants	2020-06-30	5,752,213
Balance at beginning of prior year after applicable adjustments	2020-06-30	0
Prefunding balance at beginning of prior year after applicable adjustments	2020-06-30	0
Carryover balanced portion elected for use to offset prior years funding requirement	2020-06-30	0
Prefunding balanced used to offset prior years funding requirement	2020-06-30	0
Amount remaining of carryover balance	2020-06-30	0
Amount remaining of prefunding balance	2020-06-30	0
Present value of excess contributions	2020-06-30	0
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2020-06-30	0
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2020-06-30	0
Reductions in caryover balances due to elections or deemed elections	2020-06-30	0
Reductions in prefunding balances due to elections or deemed elections	2020-06-30	0
Balance of carryovers at beginning of current year	2020-06-30	0
Balance of prefunding at beginning of current year	2020-06-30	0
Contributions allocated toward unpaid minimum require contributions from prior years	2020-06-30	0
Contributions made to avoid restrictions adjusted to valuation date	2020-06-30	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2020-06-30	0
Liquidity shortfalls end of Q1	2020-06-30	0
Liquidity shortfalls end of Q2	2020-06-30	0
Liquidity shortfalls end of Q3	2020-06-30	0
Liquidity shortfalls end of Q4	2020-06-30	0
Unpaid minimum required contributions for all prior years	2020-06-30	480,251
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2020-06-30	0
Remaining amount of unpaid minimum required contributions	2020-06-30	480,251
Minimum required contributions for current year target normal cost	2020-06-30	64,378
Net shortfall amortization installment of oustanding balance	2020-06-30	781,807
Waiver amortization installment	2020-06-30	0
Total funding amount beforereflecting carryover/prefunding balances	2020-06-30	244,265
Additional cash requirement	2020-06-30	244,265
Contributions allocatedtoward minimum required contributions for current year	2020-06-30	0
Unpaid minimum required contributions for current year	2020-06-30	244,265
Unpaid minimum required contributions for all years	2020-06-30	724,516
Total participants, beginning-of-year	2020-01-01	148
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	15
Number of retired or separated participants receiving benefits	2020-01-01	71
Number of other retired or separated participants entitled to future benefits	2020-01-01	59
Total of all active and inactive participants	2020-01-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	5
Total participants	2020-01-01	150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2019 401k membership
Market value of plan assets	2019-12-31	4,181,345
Acturial value of plan assets	2019-12-31	4,467,756
Funding target for retired participants and beneficiaries receiving payment	2019-12-31	3,076,764
Number of terminated vested participants	2019-12-31	56
Fundng target for terminated vested participants	2019-12-31	1,492,320
Active participant vested funding target	2019-12-31	1,222,912
Number of active participants	2019-12-31	25
Total funding liabilities for active participants	2019-12-31	1,222,912
Total participant count	2019-12-31	153
Total funding target for all participants	2019-12-31	5,791,996
Balance at beginning of prior year after applicable adjustments	2019-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2019-12-31	21,849
Carryover balanced portion elected for use to offset prior years funding requirement	2019-12-31	0
Prefunding balanced used to offset prior years funding requirement	2019-12-31	21,849
Amount remaining of carryover balance	2019-12-31	0
Amount remaining of prefunding balance	2019-12-31	0
Present value of excess contributions	2019-12-31	0
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2019-12-31	0
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2019-12-31	0
Reductions in caryover balances due to elections or deemed elections	2019-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2019-12-31	0
Balance of carryovers at beginning of current year	2019-12-31	0
Balance of prefunding at beginning of current year	2019-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2019-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2019-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2019-12-31	0
Liquidity shortfalls end of Q1	2019-12-31	0
Liquidity shortfalls end of Q2	2019-12-31	0
Liquidity shortfalls end of Q3	2019-12-31	0
Liquidity shortfalls end of Q4	2019-12-31	0
Unpaid minimum required contributions for all prior years	2019-12-31	102,086
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2019-12-31	0
Remaining amount of unpaid minimum required contributions	2019-12-31	102,086
Minimum required contributions for current year target normal cost	2019-12-31	73,650
Net shortfall amortization installment of oustanding balance	2019-12-31	1,324,240
Waiver amortization installment	2019-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2019-12-31	378,165
Carryover balance elected to use to offset funding requirement	2019-12-31	0
Prefunding balance elected to use to offset funding requirement	2019-12-31	0
Additional cash requirement	2019-12-31	378,165
Contributions allocatedtoward minimum required contributions for current year	2019-12-31	0
Unpaid minimum required contributions for current year	2019-12-31	378,165
Unpaid minimum required contributions for all years	2019-12-31	480,251
Total participants, beginning-of-year	2019-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	17
Number of retired or separated participants receiving benefits	2019-01-01	68
Number of other retired or separated participants entitled to future benefits	2019-01-01	57
Total of all active and inactive participants	2019-01-01	142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	6
Total participants	2019-01-01	148
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2018 401k membership
Market value of plan assets	2018-12-31	5,118,952
Acturial value of plan assets	2018-12-31	5,104,783
Funding target for retired participants and beneficiaries receiving payment	2018-12-31	2,967,001
Number of terminated vested participants	2018-12-31	75
Fundng target for terminated vested participants	2018-12-31	1,788,629
Active participant vested funding target	2018-12-31	1,469,917
Number of active participants	2018-12-31	29
Total funding liabilities for active participants	2018-12-31	1,469,917
Total participant count	2018-12-31	176
Total funding target for all participants	2018-12-31	6,225,547
Balance at beginning of prior year after applicable adjustments	2018-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2018-12-31	148
Carryover balanced portion elected for use to offset prior years funding requirement	2018-12-31	0
Prefunding balanced used to offset prior years funding requirement	2018-12-31	0
Amount remaining of carryover balance	2018-12-31	0
Amount remaining of prefunding balance	2018-12-31	148
Present value of excess contributions	2018-12-31	20,470
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2018-12-31	21,690
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2018-12-31	21,690
Reductions in caryover balances due to elections or deemed elections	2018-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2018-12-31	0
Balance of carryovers at beginning of current year	2018-12-31	0
Balance of prefunding at beginning of current year	2018-12-31	21,849
Total employer contributions	2018-12-31	68,790
Total employee contributions	2018-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2018-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2018-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2018-12-31	67,245
Liquidity shortfalls end of Q1	2018-12-31	0
Liquidity shortfalls end of Q2	2018-12-31	0
Liquidity shortfalls end of Q3	2018-12-31	0
Liquidity shortfalls end of Q4	2018-12-31	0
Unpaid minimum required contributions for all prior years	2018-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2018-12-31	0
Remaining amount of unpaid minimum required contributions	2018-12-31	0
Minimum required contributions for current year target normal cost	2018-12-31	18,090
Net shortfall amortization installment of oustanding balance	2018-12-31	1,142,613
Waiver amortization installment	2018-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2018-12-31	190,104
Carryover balance elected to use to offset funding requirement	2018-12-31	0
Prefunding balance elected to use to offset funding requirement	2018-12-31	20,773
Additional cash requirement	2018-12-31	169,331
Contributions allocatedtoward minimum required contributions for current year	2018-12-31	67,245
Unpaid minimum required contributions for current year	2018-12-31	102,086
Unpaid minimum required contributions for all years	2018-12-31	102,086
Total participants, beginning-of-year	2018-01-01	176
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	24
Number of retired or separated participants receiving benefits	2018-01-01	67
Number of other retired or separated participants entitled to future benefits	2018-01-01	56
Total of all active and inactive participants	2018-01-01	147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	5
Total participants	2018-01-01	152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2017 401k membership
Market value of plan assets	2017-12-31	4,886,667
Acturial value of plan assets	2017-12-31	5,050,696
Funding target for retired participants and beneficiaries receiving payment	2017-12-31	2,603,463
Number of terminated vested participants	2017-12-31	89
Fundng target for terminated vested participants	2017-12-31	1,988,072
Active participant vested funding target	2017-12-31	1,368,335
Number of active participants	2017-12-31	30
Total funding liabilities for active participants	2017-12-31	1,368,335
Total participant count	2017-12-31	192
Total funding target for all participants	2017-12-31	5,959,870
Balance at beginning of prior year after applicable adjustments	2017-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2017-12-31	143
Carryover balanced portion elected for use to offset prior years funding requirement	2017-12-31	0
Prefunding balanced used to offset prior years funding requirement	2017-12-31	0
Amount remaining of carryover balance	2017-12-31	0
Amount remaining of prefunding balance	2017-12-31	143
Present value of excess contributions	2017-12-31	114
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2017-12-31	121
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2017-12-31	0
Reductions in caryover balances due to elections or deemed elections	2017-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2017-12-31	0
Balance of carryovers at beginning of current year	2017-12-31	0
Balance of prefunding at beginning of current year	2017-12-31	148
Total employer contributions	2017-12-31	215,958
Total employee contributions	2017-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2017-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2017-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2017-12-31	209,346
Liquidity shortfalls end of Q1	2017-12-31	0
Liquidity shortfalls end of Q2	2017-12-31	0
Liquidity shortfalls end of Q3	2017-12-31	0
Liquidity shortfalls end of Q4	2017-12-31	0
Unpaid minimum required contributions for all prior years	2017-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2017-12-31	0
Remaining amount of unpaid minimum required contributions	2017-12-31	0
Minimum required contributions for current year target normal cost	2017-12-31	8,693
Net shortfall amortization installment of oustanding balance	2017-12-31	909,322
Waiver amortization installment	2017-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2017-12-31	188,876
Additional cash requirement	2017-12-31	188,876
Contributions allocatedtoward minimum required contributions for current year	2017-12-31	209,346
Unpaid minimum required contributions for current year	2017-12-31	0
Unpaid minimum required contributions for all years	2017-12-31	0
Total participants, beginning-of-year	2017-01-01	192
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	28
Number of retired or separated participants receiving benefits	2017-01-01	68
Number of other retired or separated participants entitled to future benefits	2017-01-01	75
Total of all active and inactive participants	2017-01-01	171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	5
Total participants	2017-01-01	176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0

Financial Data on PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL

Measure	Date	Value
2020 : PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2020 401k financial data
Total transfer of assets from this plan	2020-06-30	$4,026,002
Total income from all sources (including contributions)	2020-06-30	$-70,283
Total of all expenses incurred	2020-06-30	$271,035
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-06-30	$254,654
Value of total assets at end of year	2020-06-30	$0
Value of total assets at beginning of year	2020-06-30	$4,367,320
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-06-30	$16,381
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-06-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2020-06-30	$0
Was this plan covered by a fidelity bond	2020-06-30	Yes
Value of fidelity bond cover	2020-06-30	$500,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2020-06-30	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Value of net income/loss	2020-06-30	$-341,318
Value of net assets at end of year (total assets less liabilities)	2020-06-30	$0
Value of net assets at beginning of year (total assets less liabilities)	2020-06-30	$4,367,320
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-06-30	No
Were any leases to which the plan was party in default or uncollectible	2020-06-30	No
Investment advisory and management fees	2020-06-30	$16,381
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-06-30	$4,077,298
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-06-30	$290,022
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-06-30	$290,022
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-06-30	$-70,283
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-06-30	No
Was there a failure to transmit to the plan any participant contributions	2020-06-30	No
Has the plan failed to provide any benefit when due under the plan	2020-06-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-06-30	$254,654
Did the plan have assets held for investment	2020-06-30	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	2020-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-06-30	Yes
2019 : PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$713,386
Total income from all sources (including contributions)	2019-12-31	$713,386
Total of all expenses incurred	2019-12-31	$527,411
Total of all expenses incurred	2019-12-31	$527,411
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$389,565
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$389,565
Value of total assets at end of year	2019-12-31	$4,367,320
Value of total assets at end of year	2019-12-31	$4,367,320
Value of total assets at beginning of year	2019-12-31	$4,181,345
Value of total assets at beginning of year	2019-12-31	$4,181,345
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$137,846
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$137,846
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
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
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	$185,975
Value of net income/loss	2019-12-31	$185,975
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$4,367,320
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$4,367,320
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,181,345
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,181,345
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
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$137,846
Investment advisory and management fees	2019-12-31	$137,846
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$4,077,298
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$4,077,298
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,927,472
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,927,472
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$290,022
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$290,022
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$253,873
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$253,873
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$253,873
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$253,873
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$713,386
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$713,386
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	$389,565
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$389,565
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
2018 : PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$-133,276
Total of all expenses incurred	2018-12-31	$804,331
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$684,667
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$68,805
Value of total assets at end of year	2018-12-31	$4,181,346
Value of total assets at beginning of year	2018-12-31	$5,118,953
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$119,664
Total interest from all sources	2018-12-31	$58,968
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$3,354
Total non interest bearing cash at end of year	2018-12-31	$23,231
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	$-937,607
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$4,181,346
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$5,118,953
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$119,664
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$3,927,472
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$4,511,073
Interest earned on other investments	2018-12-31	$58,968
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$227,289
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$607,880
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-261,049
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$68,805
Employer contributions (assets) at end of year	2018-12-31	$0
Employer contributions (assets) at beginning of year	2018-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$684,667
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	GRAY, GRIFFITH & MAYS, A.C.
Accountancy firm EIN	2018-12-31	550621482
2017 : PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2017 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$557,205
Total of all expenses incurred	2017-12-31	$348,322
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$320,691
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$215,958
Value of total assets at end of year	2017-12-31	$5,118,953
Value of total assets at beginning of year	2017-12-31	$4,910,070
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$27,631
Total interest from all sources	2017-12-31	$13,188
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
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	$208,883
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$5,118,953
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$4,910,070
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$4,511,073
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$3,389,297
Interest earned on other investments	2017-12-31	$13,188
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$607,880
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$1,386,942
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$328,059
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$215,958
Employer contributions (assets) at end of year	2017-12-31	$0
Employer contributions (assets) at beginning of year	2017-12-31	$133,831
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$320,691
Contract administrator fees	2017-12-31	$27,631
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	BROWN EDWARDS & COMPANY LLP
Accountancy firm EIN	2017-12-31	540504608

Form 5500 Responses for PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL

2020: PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	Yes
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: PENSION PLAN FOR EMPLOYEES OF HIGHLAND HOSPITAL 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

GAP-B2-GX1Q

Policy instance

Insurance contract or identification number	GAP-B2-GX1Q
Number of Individuals Covered	0
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	1
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes

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

Policy contract number

GAP-B2-GX1Q

Policy instance

Insurance contract or identification number	GAP-B2-GX1Q
Number of Individuals Covered	176
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $559
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	1
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $559
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	MSI FINANCIAL SERVICES, INC.

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Company Name:	MBH HOSPITAL, LLC DBA HIGHLAND HOSPITAL
Employer identification number (EIN):	822364266
NAIC Classification:	622000
NAIC Description:	Hospitals