401k Plan data: NETWORK HEALTH PLAN 401K SAVINGS PLAN plan

NETWORK HEALTH PLAN 401K SAVINGS PLAN 401k Plan overview

Plan Name	NETWORK HEALTH PLAN 401K SAVINGS PLAN
Plan identification number	002

NETWORK HEALTH PLAN 401K SAVINGS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Participant-directed brokerage accounts provided as an investment option under the plan.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

NETWORK HEALTH PLAN has sponsored the creation of one or more 401k plans.

Company Name: NETWORK HEALTH PLAN

Employer identification number (EIN): 391442058

NAIC Classification: 524290

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NETWORK HEALTH PLAN 401K SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2014-01-01 PENELOPE RANSOM
002 2014-01-01 PENELOPE RANSOM
002 2013-01-01 CATHERINE JUNG
002 2012-01-01 CATHERINE JUNG

Plan id#	Filing Submission Date	Name of Administrator
002	2014-01-01	PENELOPE RANSOM
002	2014-01-01	PENELOPE RANSOM
002	2013-01-01	CATHERINE JUNG
002	2012-01-01	CATHERINE JUNG

Plan Statistics for NETWORK HEALTH PLAN 401K SAVINGS PLAN

401k plan membership statisitcs for NETWORK HEALTH PLAN 401K SAVINGS PLAN

Measure Date Value
2014: NETWORK HEALTH PLAN 401K SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 206
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 209
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 209
Number of participants with account balances 2014-01-01 209
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: NETWORK HEALTH PLAN 401K SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 191
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 196
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 10
Total of all active and inactive participants 2013-01-01 206
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 206
Number of participants with account balances 2013-01-01 206
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: NETWORK HEALTH PLAN 401K SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 191
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 191
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 191
Number of participants with account balances 2012-01-01 191
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2014: NETWORK HEALTH PLAN 401K SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	206
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	209
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	209
Number of participants with account balances	2014-01-01	209
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: NETWORK HEALTH PLAN 401K SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	191
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	196
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	10
Total of all active and inactive participants	2013-01-01	206
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	206
Number of participants with account balances	2013-01-01	206
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: NETWORK HEALTH PLAN 401K SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	191
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	191
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	191
Number of participants with account balances	2012-01-01	191
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on NETWORK HEALTH PLAN 401K SAVINGS PLAN

Measure	Date	Value
2014 : NETWORK HEALTH PLAN 401K 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	$1,291,363
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$457,252
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$445,743
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,167,294
Value of total assets at end of year	2014-12-31	$3,233,831
Value of total assets at beginning of year	2014-12-31	$2,399,720
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$11,509
Total interest from all sources	2014-12-31	$8,052
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$29,454
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	$29,454
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$20,000,000
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
Contributions received from participants	2014-12-31	$1,009,424
Participant contributions at end of year	2014-12-31	$57,153
Participant contributions at beginning of year	2014-12-31	$9,398
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$157,870
Other income not declared elsewhere	2014-12-31	$1,836
Administrative expenses (other) incurred	2014-12-31	$11,509
Total non interest bearing cash at end of year	2014-12-31	$3,176,678
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	$834,111
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$3,233,831
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,399,720
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 beginning of year	2014-12-31	$1,879,179
Interest on participant loans	2014-12-31	$1,290
Interest earned on other investments	2014-12-31	$6,762
Value of interest in common/collective trusts at beginning of year	2014-12-31	$217,465
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$293,678
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$84,727
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	$445,743
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	MCGLADREY, LLP
Accountancy firm EIN	2014-12-31	420714325
2013 : NETWORK HEALTH PLAN 401K 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	$1,469,835
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$341,999
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$332,124
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$1,171,173
Value of total assets at end of year	2013-12-31	$2,399,720
Value of total assets at beginning of year	2013-12-31	$1,271,884
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$9,875
Total interest from all sources	2013-12-31	$5,614
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$21,991
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$21,991
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$20,000,000
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
Contributions received from participants	2013-12-31	$943,915
Participant contributions at end of year	2013-12-31	$9,398
Participant contributions at beginning of year	2013-12-31	$1,732
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$227,258
Other income not declared elsewhere	2013-12-31	$2,123
Administrative expenses (other) incurred	2013-12-31	$9,875
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	$1,127,836
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,399,720
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,271,884
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	$1,879,179
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,021,273
Interest on participant loans	2013-12-31	$224
Interest earned on other investments	2013-12-31	$5,390
Value of interest in common/collective trusts at end of year	2013-12-31	$217,465
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$293,678
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$248,879
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$268,934
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	$332,124
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	MCGLADREY, LLP
Accountancy firm EIN	2013-12-31	420714325
2012 : NETWORK HEALTH PLAN 401K 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	$1,300,601
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$28,717
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$23,105
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$1,245,279
Value of total assets at end of year	2012-12-31	$1,271,884
Value of total assets at beginning of year	2012-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$5,612
Total interest from all sources	2012-12-31	$3,128
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$11,496
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$11,496
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$15,000,000
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
Contributions received from participants	2012-12-31	$913,045
Participant contributions at end of year	2012-12-31	$1,732
Participant contributions at beginning of year	2012-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$332,234
Other income not declared elsewhere	2012-12-31	$403
Administrative expenses (other) incurred	2012-12-31	$5,612
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	$1,271,884
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,271,884
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$0
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	$1,021,273
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$0
Interest on participant loans	2012-12-31	$3
Interest earned on other investments	2012-12-31	$3,125
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$248,879
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$40,295
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	$23,105
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	MCGLADREY, LLP
Accountancy firm EIN	2012-12-31	420714325

Form 5500 Responses for NETWORK HEALTH PLAN 401K SAVINGS PLAN

2014: NETWORK HEALTH PLAN 401K 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: NETWORK HEALTH PLAN 401K 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: NETWORK HEALTH PLAN 401K SAVINGS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

041894

Policy instance

Insurance contract or identification number	041894
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
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

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

041894

Policy instance

Insurance contract or identification number	041894
Number of Individuals Covered	206
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
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

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

041894

Policy instance

Insurance contract or identification number	041894
Number of Individuals Covered	191
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $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

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Company Name:	NETWORK HEALTH PLAN
Employer identification number (EIN):	391442058
NAIC Classification:	524290