401k Plan data: GROVE CITY HEALTH SYSTEM 401(K) PLAN plan

GROVE CITY HEALTH SYSTEM 401(K) PLAN 401k Plan overview

Plan Name	GROVE CITY HEALTH SYSTEM 401(K) PLAN
Plan identification number	002

GROVE CITY HEALTH SYSTEM 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

GROVE CITY HEALTH SYSTEM has sponsored the creation of one or more 401k plans.

Company Name: GROVE CITY HEALTH SYSTEM

Employer identification number (EIN): 320070801

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROVE CITY HEALTH SYSTEM 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2020-01-01 BETH ROSS 2021-10-11
002 2019-01-01 CINDY GREEN 2020-10-13
002 2018-01-01 DAVID POLAND 2019-10-01
002 2017-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2020-01-01	BETH ROSS	2021-10-11
002	2019-01-01	CINDY GREEN	2020-10-13
002	2018-01-01	DAVID POLAND	2019-10-01
002	2017-01-01

Plan Statistics for GROVE CITY HEALTH SYSTEM 401(K) PLAN

401k plan membership statisitcs for GROVE CITY HEALTH SYSTEM 401(K) PLAN

Measure Date Value
2020: GROVE CITY HEALTH SYSTEM 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 349
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 0
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 0
Number of participants with account balances 2020-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 4
2019: GROVE CITY HEALTH SYSTEM 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 371
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 289
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 42
Total of all active and inactive participants 2019-01-01 332
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 332
Number of participants with account balances 2019-01-01 304
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 7
2018: GROVE CITY HEALTH SYSTEM 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 402
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 296
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 57
Total of all active and inactive participants 2018-01-01 354
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 354
Number of participants with account balances 2018-01-01 344
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 13
2017: GROVE CITY HEALTH SYSTEM 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 384
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 325
Number of retired or separated participants receiving benefits 2017-01-01 3
Number of other retired or separated participants entitled to future benefits 2017-01-01 53
Total of all active and inactive participants 2017-01-01 381
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 1
Total participants 2017-01-01 382
Number of participants with account balances 2017-01-01 364
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 6

Measure	Date	Value
2020: GROVE CITY HEALTH SYSTEM 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	349
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	0
Number of participants with account balances	2020-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	4
2019: GROVE CITY HEALTH SYSTEM 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	371
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	289
Number of retired or separated participants receiving benefits	2019-01-01	1
Number of other retired or separated participants entitled to future benefits	2019-01-01	42
Total of all active and inactive participants	2019-01-01	332
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	332
Number of participants with account balances	2019-01-01	304
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	7
2018: GROVE CITY HEALTH SYSTEM 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	402
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	296
Number of retired or separated participants receiving benefits	2018-01-01	1
Number of other retired or separated participants entitled to future benefits	2018-01-01	57
Total of all active and inactive participants	2018-01-01	354
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	354
Number of participants with account balances	2018-01-01	344
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	13
2017: GROVE CITY HEALTH SYSTEM 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	384
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	325
Number of retired or separated participants receiving benefits	2017-01-01	3
Number of other retired or separated participants entitled to future benefits	2017-01-01	53
Total of all active and inactive participants	2017-01-01	381
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	1
Total participants	2017-01-01	382
Number of participants with account balances	2017-01-01	364
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	6

Financial Data on GROVE CITY HEALTH SYSTEM 401(K) PLAN

Measure	Date	Value
2020 : GROVE CITY HEALTH SYSTEM 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total transfer of assets from this plan	2020-12-31	$13,151,699
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$2,794,519
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$7,196,212
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$7,126,918
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$949,531
Value of total assets at end of year	2020-12-31	$0
Value of total assets at beginning of year	2020-12-31	$17,553,392
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$69,294
Total interest from all sources	2020-12-31	$226
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Administrative expenses professional fees incurred	2020-12-31	$7,333
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$806,009
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$25,564
Other income not declared elsewhere	2020-12-31	$136
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	$-4,401,693
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$17,553,392
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$17,553,069
Interest earned on other investments	2020-12-31	$226
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$323
Net investment gain/loss from pooled separate accounts	2020-12-31	$1,844,626
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	Yes
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$117,958
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$7,126,918
Contract administrator fees	2020-12-31	$61,961
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2020-12-31	Yes
Did the plan have assets held for investment	2020-12-31	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	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	Yes
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	BAKER TILLY US, LLP
Accountancy firm EIN	2020-12-31	390859910
2019 : GROVE CITY HEALTH SYSTEM 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$4,312,569
Total income from all sources (including contributions)	2019-12-31	$4,312,569
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$3,608,302
Total of all expenses incurred	2019-12-31	$3,608,302
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$3,528,156
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$3,528,156
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,010,272
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,010,272
Value of total assets at end of year	2019-12-31	$17,553,392
Value of total assets at end of year	2019-12-31	$17,553,392
Value of total assets at beginning of year	2019-12-31	$16,849,125
Value of total assets at beginning of year	2019-12-31	$16,849,125
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$80,146
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$80,146
Total interest from all sources	2019-12-31	$0
Total interest from all sources	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Administrative expenses professional fees incurred	2019-12-31	$6,217
Administrative expenses professional fees incurred	2019-12-31	$6,217
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
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
Contributions received from participants	2019-12-31	$842,363
Contributions received from participants	2019-12-31	$842,363
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$51,726
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$51,726
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	$704,267
Value of net income/loss	2019-12-31	$704,267
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$17,553,392
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$17,553,392
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$16,849,125
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$16,849,125
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$17,553,069
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$17,553,069
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$16,844,668
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$16,844,668
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$323
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$323
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$4,457
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$4,457
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$3,302,297
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$3,302,297
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	Yes
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
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
Contributions received in cash from employer	2019-12-31	$116,183
Contributions received in cash from employer	2019-12-31	$116,183
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$3,528,156
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$3,528,156
Contract administrator fees	2019-12-31	$73,929
Contract administrator fees	2019-12-31	$73,929
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	MCGILL, POWER, BELL & ASSOC LLP
Accountancy firm name	2019-12-31	MCGILL, POWER, BELL & ASSOC LLP
Accountancy firm EIN	2019-12-31	251031405
Accountancy firm EIN	2019-12-31	251031405
2018 : GROVE CITY HEALTH SYSTEM 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$242,621
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$2,540,576
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$2,458,871
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$1,192,847
Value of total assets at end of year	2018-12-31	$16,849,125
Value of total assets at beginning of year	2018-12-31	$19,147,080
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$81,705
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$854,355
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$74,480
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	$-2,297,955
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$16,849,125
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$19,147,080
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$16,844,668
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$19,145,960
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$4,457
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$1,120
Net investment gain/loss from pooled separate accounts	2018-12-31	$-950,226
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$264,012
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$2,458,871
Contract administrator fees	2018-12-31	$81,705
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	MCGILL, POWER, BELL & ASSOC LLP
Accountancy firm EIN	2018-12-31	251031405
2017 : GROVE CITY HEALTH SYSTEM 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
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	$3,990,102
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$2,481,711
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$2,417,946
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,229,718
Value of total assets at end of year	2017-12-31	$19,147,080
Value of total assets at beginning of year	2017-12-31	$17,638,689
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$63,765
Total interest from all sources	2017-12-31	$17,496
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$6,914
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$6,914
Administrative expenses professional fees incurred	2017-12-31	$3,050
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	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$866,225
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$95,249
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	$1,508,391
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$19,147,080
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$17,638,689
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
Investment advisory and management fees	2017-12-31	$50,793
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$19,145,960
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$2,222,928
Value of interest in pooled separate accounts at end of year	2017-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$14,951,802
Interest earned on other investments	2017-12-31	$17,496
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$1,120
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$463,959
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$178,310
Net investment gain/loss from pooled separate accounts	2017-12-31	$2,557,664
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	$268,244
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$2,417,946
Contract administrator fees	2017-12-31	$9,922
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	Yes
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	MCGILL, POWER, BELL & ASSOC LLP
Accountancy firm EIN	2017-12-31	251031405

Form 5500 Responses for GROVE CITY HEALTH SYSTEM 401(K) PLAN

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

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

129064

Policy instance

Insurance contract or identification number	129064
Number of Individuals Covered	0
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $23,938
Total amount of fees paid to insurance company	USD $26,448
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,938
Insurance broker organization code?	3
Amount paid for insurance broker fees	14848
Additional information about fees paid to insurance broker	ADMINISTRATION FEES (TWO YEARS)

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

129064

Policy instance

Insurance contract or identification number	129064
Number of Individuals Covered	304
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $26,221
Total amount of fees paid to insurance company	USD $17,920
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,221
Insurance broker organization code?	3
Amount paid for insurance broker fees	11600
Additional information about fees paid to insurance broker	AUDIT

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

129064

Policy instance

Insurance contract or identification number	129064
Number of Individuals Covered	386
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $27,976
Total amount of fees paid to insurance company	USD $7,877
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	7877
Additional information about fees paid to insurance broker	TO OFFSET FEES
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $27,976

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

432025

Policy instance

Insurance contract or identification number	432025
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-04-28
Total amount of commissions paid to insurance broker	USD $11,219
Total amount of fees paid to insurance company	USD $1,477
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,219
Amount paid for insurance broker fees	1477
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN MUTUAL INVESTMENT SERV

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

129064

Policy instance

Insurance contract or identification number	129064
Number of Individuals Covered	405
Insurance policy start date	2017-05-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $16,521
Total amount of fees paid to insurance company	USD $850
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,521
Insurance broker organization code?	3
Amount paid for insurance broker fees	850
Additional information about fees paid to insurance broker	TO OFFSET FEES
Insurance broker name	WALKER BENEFITS, LLC

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Company Name:	GROVE CITY HEALTH SYSTEM
Employer identification number (EIN):	320070801
NAIC Classification:	622000
NAIC Description:	Hospitals