401k Plan data: VALLEY HEALTH SYSTEMS GROUP BENEFIT PLAN plan

VALLEY HEALTH SYSTEMS GROUP BENEFIT PLAN 401k Plan overview

Plan Name	VALLEY HEALTH SYSTEMS GROUP BENEFIT PLAN
Plan identification number	511

VALLEY HEALTH SYSTEMS GROUP BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

THE SOCIETY OF THE VALLEY HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: THE SOCIETY OF THE VALLEY HOSPITAL

Employer identification number (EIN): 221487307

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VALLEY HEALTH SYSTEMS GROUP BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
511 2017-01-01 JOHN PACKARD JOHN PACKARD 2018-05-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
511	2017-01-01	JOHN PACKARD		JOHN PACKARD	2018-05-17

Plan Statistics for VALLEY HEALTH SYSTEMS GROUP BENEFIT PLAN

401k plan membership statisitcs for VALLEY HEALTH SYSTEMS GROUP BENEFIT PLAN

Measure Date Value
2017: VALLEY HEALTH SYSTEMS GROUP BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 3,403
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 3,434
Number of retired or separated participants receiving benefits 2017-01-01 89
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 3,523

Measure	Date	Value
2017: VALLEY HEALTH SYSTEMS GROUP BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	3,403
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	3,434
Number of retired or separated participants receiving benefits	2017-01-01	89
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	3,523

Form 5500 Responses for VALLEY HEALTH SYSTEMS GROUP BENEFIT PLAN

2017: VALLEY HEALTH SYSTEMS GROUP BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
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 – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

144801

Policy instance

Insurance contract or identification number	144801
Number of Individuals Covered	11
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,100
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	DISABILITY INSURANCE
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $17,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,129
Insurance broker organization code?	3
Insurance broker name	GEORGETOWN FINANCIAL GROUP INC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0183473

Policy instance

Insurance contract or identification number	0183473
Number of Individuals Covered	4966
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $40
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $441,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	40
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WINSTON FINANCIAL SERVICES INC

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Company Name:	THE SOCIETY OF THE VALLEY HOSPITAL
Employer identification number (EIN):	221487307
NAIC Classification:	622000
NAIC Description:	Hospitals