401k Plan data: JOHN TOLFREE HOSPITAL 403(B) PLAN plan

JOHN TOLFREE HOSPITAL 403(B) PLAN 401k Plan overview

Plan Name	JOHN TOLFREE HOSPITAL 403(B) PLAN
Plan identification number	002

JOHN TOLFREE HOSPITAL 403(B) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
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

MIDMICHIGAN MEDICAL CENTER-WEST BRANCH has sponsored the creation of one or more 401k plans.

Company Name: MIDMICHIGAN MEDICAL CENTER-WEST BRANCH

Employer identification number (EIN): 464088182

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about MIDMICHIGAN MEDICAL CENTER-WEST BRANCH

Jurisdiction of Incorporation: Michigan Department of Licensing & Regulatory Affairs

Incorporation Date:

Company Identification Number: 71168Y

More information about MIDMICHIGAN MEDICAL CENTER-WEST BRANCH

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOHN TOLFREE HOSPITAL 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2019-01-01
002 2018-01-01
002 2017-01-01 KENT ALLEN
002 2016-01-01 KENT ALLEN
002 2015-03-16 KENT ALLEN 2016-10-17

Plan Statistics for JOHN TOLFREE HOSPITAL 403(B) PLAN

401k plan membership statisitcs for JOHN TOLFREE HOSPITAL 403(B) PLAN

Measure Date Value
2019: JOHN TOLFREE HOSPITAL 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 375
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 0
Number of participants with account balances 2019-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 45
2018: JOHN TOLFREE HOSPITAL 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 362
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 352
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 23
Total of all active and inactive participants 2018-01-01 375
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 375
Number of participants with account balances 2018-01-01 329
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 54
2017: JOHN TOLFREE HOSPITAL 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 360
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 359
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 3
Total of all active and inactive participants 2017-01-01 362
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 362
Number of participants with account balances 2017-01-01 99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: JOHN TOLFREE HOSPITAL 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 343
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 356
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 4
Total of all active and inactive participants 2016-01-01 360
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 360
Number of participants with account balances 2016-01-01 95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0

Measure	Date	Value
2019: JOHN TOLFREE HOSPITAL 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	375
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	0
Number of participants with account balances	2019-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	45
2018: JOHN TOLFREE HOSPITAL 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	362
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	352
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	23
Total of all active and inactive participants	2018-01-01	375
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	375
Number of participants with account balances	2018-01-01	329
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	54
2017: JOHN TOLFREE HOSPITAL 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	360
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	359
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	3
Total of all active and inactive participants	2017-01-01	362
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	362
Number of participants with account balances	2017-01-01	99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: JOHN TOLFREE HOSPITAL 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	343
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	356
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	4
Total of all active and inactive participants	2016-01-01	360
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	360
Number of participants with account balances	2016-01-01	95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0

Financial Data on JOHN TOLFREE HOSPITAL 403(B) PLAN

Measure	Date	Value
2019 : JOHN TOLFREE HOSPITAL 403(B) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total transfer of assets from this plan	2019-12-31	$3,847,070
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	$1,817,496
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$1,073,679
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$972,087
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,106,947
Value of total assets at end of year	2019-12-31	$0
Value of total assets at beginning of year	2019-12-31	$3,103,253
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$101,592
Total interest from all sources	2019-12-31	$8,933
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$90,884
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2019-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$90,884
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	Yes
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
Contributions received from participants	2019-12-31	$592,662
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$89,011
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$68,919
Other income not declared elsewhere	2019-12-31	$18,703
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	$743,817
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,103,253
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
Investment advisory and management fees	2019-12-31	$17,835
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$2,790,031
Interest on participant loans	2019-12-31	$4,551
Interest earned on other investments	2019-12-31	$4,382
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$170,637
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$592,029
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
Contributions received in cash from employer	2019-12-31	$445,366
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$53,574
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$972,087
Contract administrator fees	2019-12-31	$83,757
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2019-12-31	381357951
2018 : JOHN TOLFREE HOSPITAL 403(B) 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	$752,262
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$481,173
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$411,408
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$877,522
Value of total assets at end of year	2018-12-31	$3,103,253
Value of total assets at beginning of year	2018-12-31	$2,832,164
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$69,765
Total interest from all sources	2018-12-31	$6,165
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$94,698
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$94,698
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$423,343
Participant contributions at end of year	2018-12-31	$89,011
Participant contributions at beginning of year	2018-12-31	$75,532
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$21,626
Other income not declared elsewhere	2018-12-31	$18,645
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	$271,089
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$3,103,253
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,832,164
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$40,235
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$2,790,031
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$2,602,502
Interest on participant loans	2018-12-31	$3,942
Interest earned on other investments	2018-12-31	$2,223
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$170,637
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$154,130
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-244,768
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$432,553
Employer contributions (assets) at end of year	2018-12-31	$53,574
Employer contributions (assets) at beginning of year	2018-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$411,408
Contract administrator fees	2018-12-31	$29,530
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	PLANTE & MORAN, PLLC
Accountancy firm EIN	2018-12-31	381357951
2017 : JOHN TOLFREE HOSPITAL 403(B) 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	$745,283
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$171,132
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$125,573
Expenses. Certain deemed distributions of participant loans	2017-12-31	$7,522
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$350,174
Value of total assets at end of year	2017-12-31	$2,832,164
Value of total assets at beginning of year	2017-12-31	$2,258,013
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$38,037
Total interest from all sources	2017-12-31	$6,653
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$59,988
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$59,988
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$5,000,000
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
Contributions received from participants	2017-12-31	$349,647
Participant contributions at end of year	2017-12-31	$75,532
Participant contributions at beginning of year	2017-12-31	$73,132
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$527
Other income not declared elsewhere	2017-12-31	$16,321
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	$574,151
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$2,832,164
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,258,013
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Investment advisory and management fees	2017-12-31	$12,321
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$2,602,502
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$2,025,710
Interest on participant loans	2017-12-31	$3,675
Interest earned on other investments	2017-12-31	$2,978
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$154,130
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$159,171
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$312,147
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$125,573
Contract administrator fees	2017-12-31	$25,716
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	PLANTE & MORAN, PLLC
Accountancy firm EIN	2017-12-31	381357951
2016 : JOHN TOLFREE HOSPITAL 403(B) 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	$2,330,895
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$72,882
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$37,831
Expenses. Certain deemed distributions of participant loans	2016-12-31	$6,746
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$2,092,229
Value of total assets at end of year	2016-12-31	$2,258,013
Value of total assets at beginning of year	2016-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$28,305
Total interest from all sources	2016-12-31	$4,870
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$50,287
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$50,287
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$5,000,000
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
Contributions received from participants	2016-12-31	$333,570
Participant contributions at end of year	2016-12-31	$73,132
Participant contributions at beginning of year	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$1,758,659
Other income not declared elsewhere	2016-12-31	$11,310
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	$2,258,013
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,258,013
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$0
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
Investment advisory and management fees	2016-12-31	$7,510
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$2,025,710
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$0
Interest on participant loans	2016-12-31	$2,177
Interest earned on other investments	2016-12-31	$2,693
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$159,171
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$172,199
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	$37,831
Contract administrator fees	2016-12-31	$20,795
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	PLANTE & MORAN, PLLC
Accountancy firm EIN	2016-12-31	381357951

Form 5500 Responses for JOHN TOLFREE HOSPITAL 403(B) PLAN

2019: JOHN TOLFREE HOSPITAL 403(B) 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	Yes
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	Yes
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: JOHN TOLFREE HOSPITAL 403(B) 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	Yes
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: JOHN TOLFREE HOSPITAL 403(B) 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	Yes
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: JOHN TOLFREE HOSPITAL 403(B) 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

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

894058-007

Policy instance

Insurance contract or identification number	894058-007
Number of Individuals Covered	0
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?	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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

894058-007

Policy instance

Insurance contract or identification number	894058-007
Number of Individuals Covered	11
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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?	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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

894058-007

Policy instance

Insurance contract or identification number	894058-007
Number of Individuals Covered	7
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
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?	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:	MIDMICHIGAN MEDICAL CENTER-WEST BRANCH
Employer identification number (EIN):	464088182
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Michigan Department of Licensing & Regulatory Affairs
Incorporation Date:
Company Identification Number:	71168Y