401k Plan data: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN plan

CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 401k Plan overview

Plan Name	CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN
Plan identification number	002

CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL

Employer identification number (EIN): 042103555

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01
002 2021-01-01
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01 JOHN BRONHARD

Plan Statistics for CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN

401k plan membership statisitcs for CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN

Measure Date Value
2022: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 202
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 109
Number of retired or separated participants receiving benefits 2022-01-01 3
Number of other retired or separated participants entitled to future benefits 2022-01-01 64
Total of all active and inactive participants 2022-01-01 176
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 2
Total participants 2022-01-01 178
Number of participants with account balances 2022-01-01 159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 2
2021: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 219
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 127
Number of retired or separated participants receiving benefits 2021-01-01 4
Number of other retired or separated participants entitled to future benefits 2021-01-01 70
Total of all active and inactive participants 2021-01-01 201
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 1
Total participants 2021-01-01 202
Number of participants with account balances 2021-01-01 176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 3
2020: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 263
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 151
Number of retired or separated participants receiving benefits 2020-01-01 2
Number of other retired or separated participants entitled to future benefits 2020-01-01 65
Total of all active and inactive participants 2020-01-01 218
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 1
Total participants 2020-01-01 219
Number of participants with account balances 2020-01-01 187
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 2
2019: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 321
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 172
Number of retired or separated participants receiving benefits 2019-01-01 5
Number of other retired or separated participants entitled to future benefits 2019-01-01 85
Total of all active and inactive participants 2019-01-01 262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 1
Total participants 2019-01-01 263
Number of participants with account balances 2019-01-01 222
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 3
2018: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 371
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 261
Number of retired or separated participants receiving benefits 2018-01-01 3
Number of other retired or separated participants entitled to future benefits 2018-01-01 57
Total of all active and inactive participants 2018-01-01 321
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 321
Number of participants with account balances 2018-01-01 200
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 17
2017: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 404
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 326
Number of retired or separated participants receiving benefits 2017-01-01 2
Number of other retired or separated participants entitled to future benefits 2017-01-01 43
Total of all active and inactive participants 2017-01-01 371
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 371
Number of participants with account balances 2017-01-01 219
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 11

Measure	Date	Value
2022: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	202
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	109
Number of retired or separated participants receiving benefits	2022-01-01	3
Number of other retired or separated participants entitled to future benefits	2022-01-01	64
Total of all active and inactive participants	2022-01-01	176
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	2
Total participants	2022-01-01	178
Number of participants with account balances	2022-01-01	159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	2
2021: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	219
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	127
Number of retired or separated participants receiving benefits	2021-01-01	4
Number of other retired or separated participants entitled to future benefits	2021-01-01	70
Total of all active and inactive participants	2021-01-01	201
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	1
Total participants	2021-01-01	202
Number of participants with account balances	2021-01-01	176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	3
2020: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	263
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	151
Number of retired or separated participants receiving benefits	2020-01-01	2
Number of other retired or separated participants entitled to future benefits	2020-01-01	65
Total of all active and inactive participants	2020-01-01	218
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	1
Total participants	2020-01-01	219
Number of participants with account balances	2020-01-01	187
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	2
2019: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	321
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	172
Number of retired or separated participants receiving benefits	2019-01-01	5
Number of other retired or separated participants entitled to future benefits	2019-01-01	85
Total of all active and inactive participants	2019-01-01	262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	1
Total participants	2019-01-01	263
Number of participants with account balances	2019-01-01	222
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	3
2018: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	371
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	261
Number of retired or separated participants receiving benefits	2018-01-01	3
Number of other retired or separated participants entitled to future benefits	2018-01-01	57
Total of all active and inactive participants	2018-01-01	321
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	321
Number of participants with account balances	2018-01-01	200
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	17
2017: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	404
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	326
Number of retired or separated participants receiving benefits	2017-01-01	2
Number of other retired or separated participants entitled to future benefits	2017-01-01	43
Total of all active and inactive participants	2017-01-01	371
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	371
Number of participants with account balances	2017-01-01	219
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	11

Financial Data on CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN

Measure	Date	Value
2022 : CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-1,740,380
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$931,991
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$923,852
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$546,488
Value of total assets at end of year	2022-12-31	$10,781,413
Value of total assets at beginning of year	2022-12-31	$13,453,784
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$8,139
Total interest from all sources	2022-12-31	$24,305
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$703,597
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$703,597
Administrative expenses professional fees incurred	2022-12-31	$800
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$397,120
Participant contributions at end of year	2022-12-31	$181,993
Participant contributions at beginning of year	2022-12-31	$181,168
Participant contributions at end of year	2022-12-31	$6,699
Participant contributions at beginning of year	2022-12-31	$8,492
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$12,003
Other income not declared elsewhere	2022-12-31	$32,774
Administrative expenses (other) incurred	2022-12-31	$7,087
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-2,672,371
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$10,781,413
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$13,453,784
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$252
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$9,695,152
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$12,344,862
Interest on participant loans	2022-12-31	$8,226
Interest earned on other investments	2022-12-31	$8,015
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$599,030
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$624,166
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$624,166
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$8,064
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$296,287
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$289,322
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-3,047,544
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$137,365
Employer contributions (assets) at end of year	2022-12-31	$2,252
Employer contributions (assets) at beginning of year	2022-12-31	$5,774
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$923,852
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	COHNREZNICK LLP
Accountancy firm EIN	2022-12-31	221478099
2021 : CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$2,339,560
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$1,663,861
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$1,627,400
Expenses. Certain deemed distributions of participant loans	2021-12-31	$10,889
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$594,163
Value of total assets at end of year	2021-12-31	$13,453,784
Value of total assets at beginning of year	2021-12-31	$12,778,085
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$25,572
Total interest from all sources	2021-12-31	$17,257
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$996,051
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$996,051
Administrative expenses professional fees incurred	2021-12-31	$14,790
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$439,735
Participant contributions at end of year	2021-12-31	$181,168
Participant contributions at beginning of year	2021-12-31	$160,751
Participant contributions at end of year	2021-12-31	$8,492
Participant contributions at beginning of year	2021-12-31	$7,208
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$3,693
Other income not declared elsewhere	2021-12-31	$30,726
Administrative expenses (other) incurred	2021-12-31	$10,105
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$675,699
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$13,453,784
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$12,778,085
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$677
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$12,344,862
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$11,597,923
Interest on participant loans	2021-12-31	$9,123
Interest earned on other investments	2021-12-31	$8,055
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$624,166
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$651,117
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$651,117
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$79
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$289,322
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$358,221
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$701,363
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$150,735
Employer contributions (assets) at end of year	2021-12-31	$5,774
Employer contributions (assets) at beginning of year	2021-12-31	$2,865
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$1,627,400
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	COHNREZNICK LLP
Accountancy firm EIN	2021-12-31	221478099
2020 : CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY 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	$2,301,136
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$905,359
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$889,907
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$617,947
Value of total assets at end of year	2020-12-31	$12,778,085
Value of total assets at beginning of year	2020-12-31	$11,382,308
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$15,452
Total interest from all sources	2020-12-31	$18,678
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$495,920
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$495,920
Administrative expenses professional fees incurred	2020-12-31	$13,670
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$7,500,000
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
Contributions received from participants	2020-12-31	$438,091
Participant contributions at end of year	2020-12-31	$160,751
Participant contributions at beginning of year	2020-12-31	$159,589
Participant contributions at end of year	2020-12-31	$7,208
Participant contributions at beginning of year	2020-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$23,313
Other income not declared elsewhere	2020-12-31	$11,142
Administrative expenses (other) incurred	2020-12-31	$1,308
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	$1,395,777
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$12,778,085
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$11,382,308
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
Investment advisory and management fees	2020-12-31	$474
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$11,597,923
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$10,048,477
Interest on participant loans	2020-12-31	$6,574
Interest earned on other investments	2020-12-31	$8,863
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$651,117
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$764,738
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$764,738
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$3,241
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$358,221
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$409,504
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$1,157,449
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
Contributions received in cash from employer	2020-12-31	$156,543
Employer contributions (assets) at end of year	2020-12-31	$2,865
Employer contributions (assets) at beginning of year	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$889,907
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	Unqualified
Accountancy firm name	2020-12-31	COHNREZNICK LLP
Accountancy firm EIN	2020-12-31	221478099
2019 : CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY 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	$2,499,582
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$588,970
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$583,723
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$548,764
Value of total assets at end of year	2019-12-31	$11,382,308
Value of total assets at beginning of year	2019-12-31	$9,471,696
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$5,247
Total interest from all sources	2019-12-31	$59,493
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$449,692
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$449,692
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$7,500,000
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
Contributions received from participants	2019-12-31	$471,342
Participant contributions at end of year	2019-12-31	$159,589
Participant contributions at beginning of year	2019-12-31	$174,227
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$1,677
Other income not declared elsewhere	2019-12-31	$10,657
Administrative expenses (other) incurred	2019-12-31	$5,247
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	$1,910,612
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$11,382,308
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$9,471,696
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	$10,048,477
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$8,106,454
Interest on participant loans	2019-12-31	$8,520
Interest earned on other investments	2019-12-31	$9,893
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$764,738
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$781,209
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$781,209
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$41,080
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$409,504
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$409,806
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$1,430,976
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	$75,745
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$583,723
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	COHNREZNICK LLP
Accountancy firm EIN	2019-12-31	221478099
2018 : CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2018-12-31	$-1
Total unrealized appreciation/depreciation of assets	2018-12-31	$-1
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	$216,719
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$1,528,672
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,527,129
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$655,888
Value of total assets at end of year	2018-12-31	$9,471,696
Value of total assets at beginning of year	2018-12-31	$10,783,649
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$1,543
Total interest from all sources	2018-12-31	$30,966
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$463,099
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$463,099
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$7,500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$518,160
Participant contributions at end of year	2018-12-31	$174,227
Participant contributions at beginning of year	2018-12-31	$184,892
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$10,185
Other income not declared elsewhere	2018-12-31	$10,292
Administrative expenses (other) incurred	2018-12-31	$1,543
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	$-1,311,953
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$9,471,696
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$10,783,649
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	$8,106,454
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$9,247,901
Interest on participant loans	2018-12-31	$8,392
Interest earned on other investments	2018-12-31	$9,980
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$781,209
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$904,860
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$904,860
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$12,594
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$409,806
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$433,925
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-943,525
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	$137,728
Employer contributions (assets) at end of year	2018-12-31	$0
Employer contributions (assets) at beginning of year	2018-12-31	$1,886
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$1,527,129
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	COHNREZNICK LLP
Accountancy firm EIN	2018-12-31	221478099
2017 : CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY 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	$2,309,981
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$1,045,926
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$1,037,616
Expenses. Certain deemed distributions of participant loans	2017-12-31	$6,960
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$830,591
Value of total assets at end of year	2017-12-31	$10,783,649
Value of total assets at beginning of year	2017-12-31	$9,519,594
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$1,350
Total interest from all sources	2017-12-31	$19,553
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$461,296
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$461,296
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$7,500,000
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
Contributions received from participants	2017-12-31	$632,424
Participant contributions at end of year	2017-12-31	$184,892
Participant contributions at beginning of year	2017-12-31	$146,859
Participant contributions at end of year	2017-12-31	$10,185
Participant contributions at beginning of year	2017-12-31	$12,573
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$56,051
Other income not declared elsewhere	2017-12-31	$7,189
Administrative expenses (other) incurred	2017-12-31	$1,350
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$1,264,055
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$10,783,649
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$9,519,594
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	$9,247,901
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$8,089,720
Interest on participant loans	2017-12-31	$6,655
Interest earned on other investments	2017-12-31	$8,803
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$904,860
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$835,903
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$835,903
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$4,095
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$433,925
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$432,569
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$991,352
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	$142,116
Employer contributions (assets) at end of year	2017-12-31	$1,886
Employer contributions (assets) at beginning of year	2017-12-31	$1,970
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$1,037,616
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	BDO USA, LLP
Accountancy firm EIN	2017-12-31	135381590

Form 5500 Responses for CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN

2022: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY 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	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	Yes
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: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY 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	Yes
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: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY 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	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: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY 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: CLINTON HOSPITAL ASSOCIATION TAX SHELTERED ANNUITY 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

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

891509+006

Policy instance

Insurance contract or identification number	891509+006
Number of Individuals Covered	95
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Number of Individuals Covered	1
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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: 65676 )

Policy contract number

891509+006

Policy instance

Insurance contract or identification number	891509+006
Number of Individuals Covered	96
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Number of Individuals Covered	1
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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: 65676 )

Policy contract number

891509+006

Policy instance

Insurance contract or identification number	891509+006
Number of Individuals Covered	100
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?	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

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Number of Individuals Covered	2
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?	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: 65676 )

Policy contract number

891509+006

Policy instance

Insurance contract or identification number	891509+006
Number of Individuals Covered	106
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

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Number of Individuals Covered	2
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: 65676 )

Policy contract number

891509+006

Policy instance

Insurance contract or identification number	891509+006
Number of Individuals Covered	112
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

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Number of Individuals Covered	2
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: 65676 )

Policy contract number

891509+006

Policy instance

Insurance contract or identification number	891509+006
Number of Individuals Covered	116
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

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Number of Individuals Covered	2
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:	UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL
Employer identification number (EIN):	042103555
NAIC Classification:	622000
NAIC Description:	Hospitals