401k Plan data: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN plan

UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 401k Plan overview

Plan Name	UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN
Plan identification number	002

UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

UPPER VALLEY MEDICAL CENTER has sponsored the creation of one or more 401k plans.

Company Name: UPPER VALLEY MEDICAL CENTER

Employer identification number (EIN): 341850683

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about UPPER VALLEY MEDICAL CENTER

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1926-09-10

Company Identification Number: 123017

Legal Registered Office Address: 110 N. MAIN ST.
STE 900
DAYTON
United States of America (USA)
45402

More information about UPPER VALLEY MEDICAL CENTER

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2021-01-01
002 2020-01-01
002 2019-01-01
002 2018-01-01 BARBARA JOHNSON 2019-09-10
002 2017-01-01
002 2016-01-01 BARBARA JOHNSON
002 2015-01-01 BARBARA JOHNSON
002 2014-01-01 BARBARA JOHNSON BARBARA JOHNSON 2015-09-28
002 2013-01-01 BARBARA JOHNSON
002 2012-01-01 WILLIAM LINESCH WILLIAM LINESCH 2013-10-11
002 2011-01-01 TRACY MOSER
002 2009-01-01 TRACY MOSER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2021-01-01
002	2020-01-01
002	2019-01-01
002	2018-01-01	BARBARA JOHNSON	2019-09-10
002	2017-01-01
002	2016-01-01	BARBARA JOHNSON
002	2015-01-01	BARBARA JOHNSON
002	2014-01-01	BARBARA JOHNSON		BARBARA JOHNSON	2015-09-28
002	2013-01-01	BARBARA JOHNSON
002	2012-01-01	WILLIAM LINESCH		WILLIAM LINESCH	2013-10-11
002	2011-01-01	TRACY MOSER
002	2009-01-01	TRACY MOSER

Plan Statistics for UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN

401k plan membership statisitcs for UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN

Measure Date Value
2021: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 180
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 0
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 0
Number of participants with account balances 2021-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 192
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 121
Number of retired or separated participants receiving benefits 2020-01-01 6
Number of other retired or separated participants entitled to future benefits 2020-01-01 51
Total of all active and inactive participants 2020-01-01 178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 2
Total participants 2020-01-01 180
Number of participants with account balances 2020-01-01 173
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 352
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 134
Number of retired or separated participants receiving benefits 2019-01-01 11
Number of other retired or separated participants entitled to future benefits 2019-01-01 46
Total of all active and inactive participants 2019-01-01 191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 1
Total participants 2019-01-01 192
Number of participants with account balances 2019-01-01 183
2018: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 347
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 257
Number of retired or separated participants receiving benefits 2018-01-01 2
Number of other retired or separated participants entitled to future benefits 2018-01-01 76
Total of all active and inactive participants 2018-01-01 335
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 17
Total participants 2018-01-01 352
Number of participants with account balances 2018-01-01 248
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 363
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 264
Number of retired or separated participants receiving benefits 2017-01-01 1
Number of other retired or separated participants entitled to future benefits 2017-01-01 82
Total of all active and inactive participants 2017-01-01 347
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 15
Total participants 2017-01-01 362
Number of participants with account balances 2017-01-01 280
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 399
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 294
Number of retired or separated participants receiving benefits 2016-01-01 2
Number of other retired or separated participants entitled to future benefits 2016-01-01 73
Total of all active and inactive participants 2016-01-01 369
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 15
Total participants 2016-01-01 384
Number of participants with account balances 2016-01-01 302
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 412
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 319
Number of retired or separated participants receiving benefits 2015-01-01 2
Number of other retired or separated participants entitled to future benefits 2015-01-01 77
Total of all active and inactive participants 2015-01-01 398
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 13
Total participants 2015-01-01 411
Number of participants with account balances 2015-01-01 330
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 439
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 334
Number of retired or separated participants receiving benefits 2014-01-01 3
Number of other retired or separated participants entitled to future benefits 2014-01-01 74
Total of all active and inactive participants 2014-01-01 411
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 12
Total participants 2014-01-01 423
Number of participants with account balances 2014-01-01 347
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 462
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 346
Number of retired or separated participants receiving benefits 2013-01-01 2
Number of other retired or separated participants entitled to future benefits 2013-01-01 81
Total of all active and inactive participants 2013-01-01 429
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 10
Total participants 2013-01-01 439
Number of participants with account balances 2013-01-01 370
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 480
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 362
Number of retired or separated participants receiving benefits 2012-01-01 2
Number of other retired or separated participants entitled to future benefits 2012-01-01 89
Total of all active and inactive participants 2012-01-01 453
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 9
Total participants 2012-01-01 462
Number of participants with account balances 2012-01-01 396
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 456
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 341
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 71
Total of all active and inactive participants 2011-01-01 414
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 8
Total participants 2011-01-01 422
Number of participants with account balances 2011-01-01 422
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,486
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,277
Number of retired or separated participants receiving benefits 2009-01-01 2
Number of other retired or separated participants entitled to future benefits 2009-01-01 229
Total of all active and inactive participants 2009-01-01 1,508
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 8
Total participants 2009-01-01 1,516
Number of participants with account balances 2009-01-01 619
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2021: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	180
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	0
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	0
Number of participants with account balances	2021-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	192
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	121
Number of retired or separated participants receiving benefits	2020-01-01	6
Number of other retired or separated participants entitled to future benefits	2020-01-01	51
Total of all active and inactive participants	2020-01-01	178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	2
Total participants	2020-01-01	180
Number of participants with account balances	2020-01-01	173
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	352
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	134
Number of retired or separated participants receiving benefits	2019-01-01	11
Number of other retired or separated participants entitled to future benefits	2019-01-01	46
Total of all active and inactive participants	2019-01-01	191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	1
Total participants	2019-01-01	192
Number of participants with account balances	2019-01-01	183
2018: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	347
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	257
Number of retired or separated participants receiving benefits	2018-01-01	2
Number of other retired or separated participants entitled to future benefits	2018-01-01	76
Total of all active and inactive participants	2018-01-01	335
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	17
Total participants	2018-01-01	352
Number of participants with account balances	2018-01-01	248
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	363
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	264
Number of retired or separated participants receiving benefits	2017-01-01	1
Number of other retired or separated participants entitled to future benefits	2017-01-01	82
Total of all active and inactive participants	2017-01-01	347
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	15
Total participants	2017-01-01	362
Number of participants with account balances	2017-01-01	280
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	399
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	294
Number of retired or separated participants receiving benefits	2016-01-01	2
Number of other retired or separated participants entitled to future benefits	2016-01-01	73
Total of all active and inactive participants	2016-01-01	369
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	15
Total participants	2016-01-01	384
Number of participants with account balances	2016-01-01	302
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	412
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	319
Number of retired or separated participants receiving benefits	2015-01-01	2
Number of other retired or separated participants entitled to future benefits	2015-01-01	77
Total of all active and inactive participants	2015-01-01	398
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	13
Total participants	2015-01-01	411
Number of participants with account balances	2015-01-01	330
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	439
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	334
Number of retired or separated participants receiving benefits	2014-01-01	3
Number of other retired or separated participants entitled to future benefits	2014-01-01	74
Total of all active and inactive participants	2014-01-01	411
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	12
Total participants	2014-01-01	423
Number of participants with account balances	2014-01-01	347
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	462
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	346
Number of retired or separated participants receiving benefits	2013-01-01	2
Number of other retired or separated participants entitled to future benefits	2013-01-01	81
Total of all active and inactive participants	2013-01-01	429
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	10
Total participants	2013-01-01	439
Number of participants with account balances	2013-01-01	370
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	480
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	362
Number of retired or separated participants receiving benefits	2012-01-01	2
Number of other retired or separated participants entitled to future benefits	2012-01-01	89
Total of all active and inactive participants	2012-01-01	453
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	9
Total participants	2012-01-01	462
Number of participants with account balances	2012-01-01	396
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	456
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	341
Number of retired or separated participants receiving benefits	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	71
Total of all active and inactive participants	2011-01-01	414
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	8
Total participants	2011-01-01	422
Number of participants with account balances	2011-01-01	422
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,486
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,277
Number of retired or separated participants receiving benefits	2009-01-01	2
Number of other retired or separated participants entitled to future benefits	2009-01-01	229
Total of all active and inactive participants	2009-01-01	1,508
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	8
Total participants	2009-01-01	1,516
Number of participants with account balances	2009-01-01	619
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN

Measure	Date	Value
2021 : UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-03-15	$0
Total transfer of assets from this plan	2021-03-15	$5,038,819
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-03-15	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-03-15	$0
Total income from all sources (including contributions)	2021-03-15	$183,786
Total loss/gain on sale of assets	2021-03-15	$0
Total of all expenses incurred	2021-03-15	$135,647
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-03-15	$134,220
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-03-15	$0
Value of total assets at end of year	2021-03-15	$0
Value of total assets at beginning of year	2021-03-15	$4,990,680
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-03-15	$1,427
Total interest from all sources	2021-03-15	$2,173
Total dividends received (eg from common stock, registered investment company shares)	2021-03-15	$17
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-03-15	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-03-15	$17
Was this plan covered by a fidelity bond	2021-03-15	Yes
Value of fidelity bond cover	2021-03-15	$1,500,000
If this is an individual account plan, was there a blackout period	2021-03-15	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-03-15	$0
Were there any nonexempt tranactions with any party-in-interest	2021-03-15	No
Administrative expenses (other) incurred	2021-03-15	$1,427
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-03-15	No
Value of net income/loss	2021-03-15	$48,139
Value of net assets at end of year (total assets less liabilities)	2021-03-15	$0
Value of net assets at beginning of year (total assets less liabilities)	2021-03-15	$4,990,680
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-03-15	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-03-15	No
Were any leases to which the plan was party in default or uncollectible	2021-03-15	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-03-15	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-03-15	$3,745,703
Interest earned on other investments	2021-03-15	$2,173
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-03-15	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-03-15	$1,244,977
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-03-15	$181,596
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-03-15	No
Was there a failure to transmit to the plan any participant contributions	2021-03-15	No
Has the plan failed to provide any benefit when due under the plan	2021-03-15	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-03-15	$134,220
Did the plan have assets held for investment	2021-03-15	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	2021-03-15	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-03-15	Yes
Opinion of an independent qualified public accountant for this plan	2021-03-15	Disclaimer
Accountancy firm name	2021-03-15	CLARK, SCHAEFER, HACKETT & CO.
Accountancy firm EIN	2021-03-15	310800053
2020 : UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
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	$550,927
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$710,855
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$703,842
Expenses. Certain deemed distributions of participant loans	2020-12-31	$141
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$0
Value of total assets at end of year	2020-12-31	$4,990,680
Value of total assets at beginning of year	2020-12-31	$5,150,608
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$6,872
Total interest from all sources	2020-12-31	$17,213
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$207,744
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$207,744
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Administrative expenses (other) incurred	2020-12-31	$6,872
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	$-159,928
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$4,990,680
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$5,150,608
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	$3,745,703
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$3,782,828
Interest earned on other investments	2020-12-31	$17,212
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$1
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$1,244,977
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$1,367,780
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$325,970
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$703,842
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	CLARK, SCHAEFER, HACKETT & CO.
Accountancy firm EIN	2020-12-31	310800053
2019 : UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2019 401k financial data
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 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	$986,058
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$1,460,251
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$1,515,779
Expenses. Certain deemed distributions of participant loans	2019-12-31	$-61,589
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$0
Value of total assets at end of year	2019-12-31	$5,150,608
Value of total assets at beginning of year	2019-12-31	$5,624,801
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$6,061
Total interest from all sources	2019-12-31	$9,746
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$150,559
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$150,559
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$1,500,000
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
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$5,991
Administrative expenses (other) incurred	2019-12-31	$4,946
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	$-474,193
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$5,150,608
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$5,624,801
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$3,782,828
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,770,296
Interest on participant loans	2019-12-31	$141
Interest earned on other investments	2019-12-31	$9,576
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$29
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,367,780
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,848,514
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$825,753
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,515,779
Contract administrator fees	2019-12-31	$1,115
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	CLARK, SCHAEFER, HACKETT & CO.
Accountancy firm EIN	2019-12-31	310800053
2018 : UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS 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	$-102,510
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$1,837,226
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,823,004
Expenses. Certain deemed distributions of participant loans	2018-12-31	$-3,248
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$0
Value of total assets at end of year	2018-12-31	$5,624,801
Value of total assets at beginning of year	2018-12-31	$7,564,537
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$17,470
Total interest from all sources	2018-12-31	$441
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	$1,500,000
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
Participant contributions at end of year	2018-12-31	$5,991
Participant contributions at beginning of year	2018-12-31	$12,264
Other income not declared elsewhere	2018-12-31	$338,206
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	$-1,939,736
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$5,624,801
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$7,564,537
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$3,770,296
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$5,188,155
Interest on participant loans	2018-12-31	$441
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$1,848,514
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$2,364,118
Net investment gain/loss from pooled separate accounts	2018-12-31	$-441,157
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$1,823,004
Contract administrator fees	2018-12-31	$17,470
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	CLARK, SCHAEFER, HACKETT & CO.
Accountancy firm EIN	2018-12-31	310800053
2017 : UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS 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	$1,090,922
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$699,404
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$714,459
Expenses. Certain deemed distributions of participant loans	2017-12-31	$-31,636
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$0
Value of total assets at end of year	2017-12-31	$7,564,537
Value of total assets at beginning of year	2017-12-31	$7,173,019
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$16,581
Total interest from all sources	2017-12-31	$667
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
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	$1,500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Participant contributions at end of year	2017-12-31	$12,264
Participant contributions at beginning of year	2017-12-31	$25,095
Other income not declared elsewhere	2017-12-31	$296,041
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	$391,518
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$7,564,537
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$7,173,019
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	$5,188,155
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$4,782,675
Interest on participant loans	2017-12-31	$667
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$2,364,118
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$2,365,249
Net investment gain/loss from pooled separate accounts	2017-12-31	$794,214
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$714,459
Contract administrator fees	2017-12-31	$16,581
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	CLARK, SCHAEFER, HACKETT & CO.
Accountancy firm EIN	2017-12-31	310800053
2016 : UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$413,312
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$943,672
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$935,764
Expenses. Certain deemed distributions of participant loans	2016-12-31	$-6,439
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$0
Value of total assets at end of year	2016-12-31	$7,173,019
Value of total assets at beginning of year	2016-12-31	$7,703,379
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$14,347
Total interest from all sources	2016-12-31	$4,091
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Participant contributions at end of year	2016-12-31	$25,095
Participant contributions at beginning of year	2016-12-31	$32,735
Other income not declared elsewhere	2016-12-31	$334,422
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-530,360
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$7,173,019
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$7,703,379
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$4,782,675
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$5,266,486
Interest on participant loans	2016-12-31	$4,091
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$2,365,249
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$2,404,158
Net investment gain/loss from pooled separate accounts	2016-12-31	$74,799
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$935,764
Contract administrator fees	2016-12-31	$14,347
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	CLARK SCHAEFER HACKETT
Accountancy firm EIN	2016-12-31	310800053
2015 : UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$180,535
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$632,186
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$518,390
Expenses. Certain deemed distributions of participant loans	2015-12-31	$105,571
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$0
Value of total assets at end of year	2015-12-31	$7,703,379
Value of total assets at beginning of year	2015-12-31	$8,155,030
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$8,225
Total interest from all sources	2015-12-31	$4,582
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Participant contributions at end of year	2015-12-31	$32,735
Participant contributions at beginning of year	2015-12-31	$43,212
Other income not declared elsewhere	2015-12-31	$428,556
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-451,651
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$7,703,379
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$8,155,030
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$5,266,486
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$5,708,054
Income. Interest from loans (other than to participants)	2015-12-31	$4,582
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$2,404,158
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$2,403,764
Net investment gain/loss from pooled separate accounts	2015-12-31	$-252,603
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$518,390
Contract administrator fees	2015-12-31	$8,225
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	CLARK SCHAEFER HACKETT
Accountancy firm EIN	2015-12-31	310800053
2014 : UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$554,758
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$553,951
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$543,642
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$0
Value of total assets at end of year	2014-12-31	$8,155,030
Value of total assets at beginning of year	2014-12-31	$8,154,223
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$10,309
Total interest from all sources	2014-12-31	$73,280
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$266,529
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$266,529
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Participant contributions at end of year	2014-12-31	$43,212
Participant contributions at beginning of year	2014-12-31	$16,781
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$807
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$8,155,030
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$8,154,223
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$5,708,054
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$5,577,766
Interest on participant loans	2014-12-31	$275
Interest earned on other investments	2014-12-31	$73,005
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$2,403,764
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$2,559,676
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$214,949
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$543,642
Contract administrator fees	2014-12-31	$10,309
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2014-12-31	381357951
2013 : UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$1,593,864
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$778,818
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$764,443
Expenses. Certain deemed distributions of participant loans	2013-12-31	$2,033
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$161,039
Value of total assets at end of year	2013-12-31	$8,154,223
Value of total assets at beginning of year	2013-12-31	$7,339,177
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$12,342
Total interest from all sources	2013-12-31	$75,299
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Participant contributions at end of year	2013-12-31	$16,781
Participant contributions at beginning of year	2013-12-31	$29,674
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$161,039
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$815,046
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$8,154,223
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$7,339,177
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$5,577,766
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$4,822,457
Interest on participant loans	2013-12-31	$395
Interest earned on other investments	2013-12-31	$74,904
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$2,559,676
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$2,487,046
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$1,357,526
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$764,443
Contract administrator fees	2013-12-31	$12,342
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2013-12-31	381357951
2012 : UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$778,904
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$455,793
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$444,457
Expenses. Certain deemed distributions of participant loans	2012-12-31	$1,511
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$0
Value of total assets at end of year	2012-12-31	$7,339,177
Value of total assets at beginning of year	2012-12-31	$7,016,066
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$9,825
Total interest from all sources	2012-12-31	$76,141
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Participant contributions at end of year	2012-12-31	$29,674
Participant contributions at beginning of year	2012-12-31	$41,040
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$323,111
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$7,339,177
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$7,016,066
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$4,822,457
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$4,490,885
Interest on participant loans	2012-12-31	$1,966
Interest earned on other investments	2012-12-31	$74,175
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$2,487,046
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$2,484,141
Net investment gain/loss from pooled separate accounts	2012-12-31	$702,763
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$444,457
Contract administrator fees	2012-12-31	$9,825
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2012-12-31	381357951
2011 : UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$-32,984
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$569,713
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$559,695
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$0
Value of total assets at end of year	2011-12-31	$7,016,066
Value of total assets at beginning of year	2011-12-31	$7,618,763
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$10,018
Total interest from all sources	2011-12-31	$74,654
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Participant contributions at end of year	2011-12-31	$41,040
Participant contributions at beginning of year	2011-12-31	$52,468
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-602,697
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$7,016,066
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$7,618,763
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$4,490,885
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$5,165,035
Interest on participant loans	2011-12-31	$3,184
Interest earned on other investments	2011-12-31	$71,470
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$2,484,141
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$2,401,260
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-107,638
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$559,695
Contract administrator fees	2011-12-31	$10,018
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2011-12-31	381357951
2010 : UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$751,377
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$914,996
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$769,134
Expenses. Certain deemed distributions of participant loans	2010-12-31	$135,766
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$0
Value of total assets at end of year	2010-12-31	$7,618,763
Value of total assets at beginning of year	2010-12-31	$7,782,382
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$10,096
Total interest from all sources	2010-12-31	$71,026
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$1,500,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Participant contributions at end of year	2010-12-31	$52,468
Participant contributions at beginning of year	2010-12-31	$263,307
Administrative expenses (other) incurred	2010-12-31	$10,096
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$-163,619
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$7,618,763
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$7,782,382
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$5,165,035
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$5,051,307
Interest on participant loans	2010-12-31	$257
Interest earned on other investments	2010-12-31	$70,769
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$2,401,260
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$2,467,768
Net investment gain/loss from pooled separate accounts	2010-12-31	$680,351
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$769,134
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2010-12-31	381357951

Form 5500 Responses for UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN

2021: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	Yes
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS 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	No
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: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS 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: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS 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: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS 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
2016: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: UPPER VALLEY MEDICAL CENTERS TAX DEFERRED ANNUITY PLAN AND SHARED SAVINGS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 60139 )

Policy contract number

895620-007

Policy instance

Insurance contract or identification number	895620-007
Number of Individuals Covered	0
Insurance policy start date	2021-01-01
Insurance policy end date	2021-03-15
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?	Yes
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

666195

Policy instance

Insurance contract or identification number	666195
Number of Individuals Covered	0
Insurance policy start date	2021-01-01
Insurance policy end date	2021-03-15
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?	Yes
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

666195

Policy instance

Insurance contract or identification number	666195
Number of Individuals Covered	63
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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?	Yes
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

LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 60139 )

Policy contract number

895620-007

Policy instance

Insurance contract or identification number	895620-007
Number of Individuals Covered	125
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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?	Yes
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

666195

Policy instance

Insurance contract or identification number	666195
Number of Individuals Covered	68
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	Yes
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

LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 60139 )

Policy contract number

895620-007

Policy instance

Insurance contract or identification number	895620-007
Number of Individuals Covered	137
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	Yes
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6058

Policy instance

Insurance contract or identification number	VF6058
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1
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?	Yes
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	1
Additional information about fees paid to insurance broker	CASH COMMISSIONS
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6007

Policy instance

Insurance contract or identification number	VF6007
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $65
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?	Yes
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	65
Additional information about fees paid to insurance broker	CASH COMMISSIONS
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6007

Policy instance

Insurance contract or identification number	VF6007
Number of Individuals Covered	29
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $254
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?	Yes
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 $254
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6058

Policy instance

Insurance contract or identification number	VF6058
Number of Individuals Covered	1
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2
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?	Yes
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 $2
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

666195

Policy instance

Insurance contract or identification number	666195
Number of Individuals Covered	248
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?	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?	Yes
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

666195

Policy instance

Insurance contract or identification number	666195
Number of Individuals Covered	280
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 $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?	Yes
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6007

Policy instance

Insurance contract or identification number	VF6007
Number of Individuals Covered	33
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $266
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?	Yes
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 $266
Insurance broker organization code?	3
Insurance broker name	LINK LAUREL M

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6058

Policy instance

Insurance contract or identification number	VF6058
Number of Individuals Covered	1
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2
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?	Yes
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 $2
Insurance broker organization code?	3
Insurance broker name	LINK LAUREL M

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VFZ195

Policy instance

Insurance contract or identification number	VFZ195
Number of Individuals Covered	330
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
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?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6007

Policy instance

Insurance contract or identification number	VF6007
Number of Individuals Covered	44
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $243
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 $243
Insurance broker organization code?	3
Insurance broker name	VOYA

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6058

Policy instance

Insurance contract or identification number	VF6058
Number of Individuals Covered	1
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 $2
Insurance broker organization code?	3
Insurance broker name	VOYA

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6007

Policy instance

Insurance contract or identification number	VF6007
Number of Individuals Covered	43
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $228
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 $228
Insurance broker organization code?	3
Insurance broker name	VOYA

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6058

Policy instance

Insurance contract or identification number	VF6058
Number of Individuals Covered	1
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 $2
Insurance broker organization code?	3
Insurance broker name	VOYA

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VFZ195

Policy instance

Insurance contract or identification number	VFZ195
Number of Individuals Covered	347
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VFZ195

Policy instance

Insurance contract or identification number	VFZ195
Number of Individuals Covered	370
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6058

Policy instance

Insurance contract or identification number	VF6058
Number of Individuals Covered	1
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 $2
Insurance broker organization code?	3
Insurance broker name	ING

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6007

Policy instance

Insurance contract or identification number	VF6007
Number of Individuals Covered	44
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $198
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 $198
Insurance broker organization code?	3
Insurance broker name	ING

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6007

Policy instance

Insurance contract or identification number	VF6007
Number of Individuals Covered	46
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $184
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 $184
Insurance broker organization code?	3
Insurance broker name	ING

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VFZ195

Policy instance

Insurance contract or identification number	VFZ195
Number of Individuals Covered	396
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $961
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $961
Insurance broker organization code?	3
Insurance broker name	ING

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6058

Policy instance

Insurance contract or identification number	VF6058
Number of Individuals Covered	1
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 $1
Insurance broker organization code?	3
Insurance broker name	ING

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VFZ195

Policy instance

Insurance contract or identification number	VFZ195
Number of Individuals Covered	422
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $16,590
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

40849

Policy instance

Insurance contract or identification number	40849
Number of Individuals Covered	17
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6058

Policy instance

Insurance contract or identification number	VF6058
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6007

Policy instance

Insurance contract or identification number	VF6007
Number of Individuals Covered	50
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $180
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6058

Policy instance

Insurance contract or identification number	VF6058
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 $1
Insurance broker organization code?	3
Insurance broker name	ING

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

40849

Policy instance

Insurance contract or identification number	40849
Number of Individuals Covered	17
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $18
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 $18
Insurance broker organization code?	3
Insurance broker name	EDWARD M. BUFFINGTON

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VF6007

Policy instance

Insurance contract or identification number	VF6007
Number of Individuals Covered	57
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $187
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 $187
Insurance broker organization code?	3
Insurance broker name	ING

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VFZ195

Policy instance

Insurance contract or identification number	VFZ195
Number of Individuals Covered	450
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $15,695
Total amount of fees paid to insurance company	USD $1
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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 $15,695
Amount paid for insurance broker fees	1
Additional information about fees paid to insurance broker	NON-CASH COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ING

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Company Name:	UPPER VALLEY MEDICAL CENTER
Employer identification number (EIN):	341850683
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1926-09-10
Company Identification Number:	123017
Legal Registered Office Address:	110 N. MAIN ST. STE 900 DAYTON United States of America (USA) 45402