401k Plan data: QHC FACILITIES, LLC 401(K) PLAN plan

QHC FACILITIES, LLC 401(K) PLAN 401k Plan overview

Plan Name	QHC FACILITIES, LLC 401(K) PLAN
Plan identification number	001

QHC FACILITIES, LLC 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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

QHC FACILITIES, LLC has sponsored the creation of one or more 401k plans.

Company Name: QHC FACILITIES, LLC

Employer identification number (EIN): 262923180

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about QHC FACILITIES, LLC

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities

Incorporation Date: 2008-06-27

Company Identification Number: 365469

Legal Registered Office Address: 8350 HICKMAN RD STE 15

DES MOINES
United States of America (USA)
50325

More information about QHC FACILITIES, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan QHC FACILITIES, LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-01-01 SAM HAIKINS 2024-06-11 SAM HAIKINS 2024-06-11
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 JERRY VOYNA
001 2016-01-01 JERRY VOYNA
001 2015-01-01 JERRY VOYNA
001 2014-01-01 JERRY VOYNA
001 2013-01-01 JERRY VOYNA
001 2012-01-01 JERRY VOYNA
001 2011-01-01 JERRY VOYNA

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2021-01-01	SAM HAIKINS	2024-06-11	SAM HAIKINS	2024-06-11
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	JERRY VOYNA
001	2016-01-01	JERRY VOYNA
001	2015-01-01	JERRY VOYNA
001	2014-01-01	JERRY VOYNA
001	2013-01-01	JERRY VOYNA
001	2012-01-01	JERRY VOYNA
001	2011-01-01	JERRY VOYNA

Plan Statistics for QHC FACILITIES, LLC 401(K) PLAN

401k plan membership statisitcs for QHC FACILITIES, LLC 401(K) PLAN

Measure Date Value
2021: QHC FACILITIES, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 258
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 175
Number of retired or separated participants receiving benefits 2021-01-01 2
Number of other retired or separated participants entitled to future benefits 2021-01-01 30
Total of all active and inactive participants 2021-01-01 207
Total participants 2021-01-01 207
Number of participants with account balances 2021-01-01 87
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: QHC FACILITIES, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 323
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 196
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 34
Total of all active and inactive participants 2020-01-01 230
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 230
Number of participants with account balances 2020-01-01 98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: QHC FACILITIES, LLC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 366
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 260
Number of retired or separated participants receiving benefits 2019-01-01 2
Number of other retired or separated participants entitled to future benefits 2019-01-01 27
Total of all active and inactive participants 2019-01-01 289
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 1
Total participants 2019-01-01 290
Number of participants with account balances 2019-01-01 112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: QHC FACILITIES, LLC 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 372
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 276
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 40
Total of all active and inactive participants 2018-01-01 317
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 1
Total participants 2018-01-01 318
Number of participants with account balances 2018-01-01 140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 1
2017: QHC FACILITIES, LLC 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 410
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 299
Number of retired or separated participants receiving benefits 2017-01-01 4
Number of other retired or separated participants entitled to future benefits 2017-01-01 26
Total of all active and inactive participants 2017-01-01 329
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 1
Total participants 2017-01-01 330
Number of participants with account balances 2017-01-01 141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: QHC FACILITIES, LLC 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 446
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 350
Number of retired or separated participants receiving benefits 2016-01-01 4
Number of other retired or separated participants entitled to future benefits 2016-01-01 28
Total of all active and inactive participants 2016-01-01 382
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 1
Total participants 2016-01-01 383
Number of participants with account balances 2016-01-01 158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: QHC FACILITIES, LLC 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 458
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 354
Number of retired or separated participants receiving benefits 2015-01-01 2
Number of other retired or separated participants entitled to future benefits 2015-01-01 34
Total of all active and inactive participants 2015-01-01 390
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 1
Total participants 2015-01-01 391
Number of participants with account balances 2015-01-01 178
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: QHC FACILITIES, LLC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 482
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 387
Number of retired or separated participants receiving benefits 2014-01-01 2
Number of other retired or separated participants entitled to future benefits 2014-01-01 21
Total of all active and inactive participants 2014-01-01 410
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 1
Total participants 2014-01-01 411
Number of participants with account balances 2014-01-01 172
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: QHC FACILITIES, LLC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 498
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 414
Number of retired or separated participants receiving benefits 2013-01-01 6
Number of other retired or separated participants entitled to future benefits 2013-01-01 16
Total of all active and inactive participants 2013-01-01 436
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 2
Total participants 2013-01-01 438
Number of participants with account balances 2013-01-01 187
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: QHC FACILITIES, LLC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 499
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 421
Number of retired or separated participants receiving benefits 2012-01-01 5
Number of other retired or separated participants entitled to future benefits 2012-01-01 17
Total of all active and inactive participants 2012-01-01 443
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 444
Number of participants with account balances 2012-01-01 193
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: QHC FACILITIES, LLC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 471
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 431
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 25
Total of all active and inactive participants 2011-01-01 458
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 459
Number of participants with account balances 2011-01-01 194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2021: QHC FACILITIES, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	258
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	175
Number of retired or separated participants receiving benefits	2021-01-01	2
Number of other retired or separated participants entitled to future benefits	2021-01-01	30
Total of all active and inactive participants	2021-01-01	207
Total participants	2021-01-01	207
Number of participants with account balances	2021-01-01	87
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: QHC FACILITIES, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	323
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	196
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	34
Total of all active and inactive participants	2020-01-01	230
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	230
Number of participants with account balances	2020-01-01	98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: QHC FACILITIES, LLC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	366
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	260
Number of retired or separated participants receiving benefits	2019-01-01	2
Number of other retired or separated participants entitled to future benefits	2019-01-01	27
Total of all active and inactive participants	2019-01-01	289
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	1
Total participants	2019-01-01	290
Number of participants with account balances	2019-01-01	112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: QHC FACILITIES, LLC 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	372
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	276
Number of retired or separated participants receiving benefits	2018-01-01	1
Number of other retired or separated participants entitled to future benefits	2018-01-01	40
Total of all active and inactive participants	2018-01-01	317
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	1
Total participants	2018-01-01	318
Number of participants with account balances	2018-01-01	140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	1
2017: QHC FACILITIES, LLC 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	410
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	299
Number of retired or separated participants receiving benefits	2017-01-01	4
Number of other retired or separated participants entitled to future benefits	2017-01-01	26
Total of all active and inactive participants	2017-01-01	329
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	1
Total participants	2017-01-01	330
Number of participants with account balances	2017-01-01	141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: QHC FACILITIES, LLC 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	446
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	350
Number of retired or separated participants receiving benefits	2016-01-01	4
Number of other retired or separated participants entitled to future benefits	2016-01-01	28
Total of all active and inactive participants	2016-01-01	382
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	1
Total participants	2016-01-01	383
Number of participants with account balances	2016-01-01	158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: QHC FACILITIES, LLC 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	458
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	354
Number of retired or separated participants receiving benefits	2015-01-01	2
Number of other retired or separated participants entitled to future benefits	2015-01-01	34
Total of all active and inactive participants	2015-01-01	390
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	1
Total participants	2015-01-01	391
Number of participants with account balances	2015-01-01	178
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: QHC FACILITIES, LLC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	482
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	387
Number of retired or separated participants receiving benefits	2014-01-01	2
Number of other retired or separated participants entitled to future benefits	2014-01-01	21
Total of all active and inactive participants	2014-01-01	410
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	1
Total participants	2014-01-01	411
Number of participants with account balances	2014-01-01	172
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: QHC FACILITIES, LLC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	498
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	414
Number of retired or separated participants receiving benefits	2013-01-01	6
Number of other retired or separated participants entitled to future benefits	2013-01-01	16
Total of all active and inactive participants	2013-01-01	436
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	2
Total participants	2013-01-01	438
Number of participants with account balances	2013-01-01	187
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: QHC FACILITIES, LLC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	499
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	421
Number of retired or separated participants receiving benefits	2012-01-01	5
Number of other retired or separated participants entitled to future benefits	2012-01-01	17
Total of all active and inactive participants	2012-01-01	443
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	444
Number of participants with account balances	2012-01-01	193
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: QHC FACILITIES, LLC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	471
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	431
Number of retired or separated participants receiving benefits	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	25
Total of all active and inactive participants	2011-01-01	458
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	459
Number of participants with account balances	2011-01-01	194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on QHC FACILITIES, LLC 401(K) PLAN

Measure	Date	Value
2021 : QHC FACILITIES, LLC 401(K) PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-12-31	$200,085
Total of all expenses incurred	2021-12-31	$92,644
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$81,912
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$64,950
Value of total assets at end of year	2021-12-31	$1,420,286
Value of total assets at beginning of year	2021-12-31	$1,312,845
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$10,732
Total interest from all sources	2021-12-31	$11,413
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$200,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$64,950
Participant contributions at end of year	2021-12-31	$71,366
Participant contributions at beginning of year	2021-12-31	$31,152
Participant contributions at end of year	2021-12-31	$0
Participant contributions at beginning of year	2021-12-31	$0
Other income not declared elsewhere	2021-12-31	$-12,522
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	$107,441
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$1,420,286
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$1,312,845
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$973,486
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$846,562
Interest on participant loans	2021-12-31	$2,444
Interest earned on other investments	2021-12-31	$8,969
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$375,434
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$435,131
Net investment gain/loss from pooled separate accounts	2021-12-31	$136,244
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$81,912
Contract administrator fees	2021-12-31	$10,732
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	2021-12-31	No
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	Disclaimer
Accountancy firm name	2021-12-31	DENMAN CPA LLP
Accountancy firm EIN	2021-12-31	420794029
2020 : QHC FACILITIES, LLC 401(K) 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	$227,618
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$191,269
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$180,371
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$80,178
Value of total assets at end of year	2020-12-31	$1,312,845
Value of total assets at beginning of year	2020-12-31	$1,276,496
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$10,898
Total interest from all sources	2020-12-31	$11,727
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$200,000
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	$77,066
Participant contributions at end of year	2020-12-31	$31,152
Participant contributions at beginning of year	2020-12-31	$40,999
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$3,103
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$3,112
Other income not declared elsewhere	2020-12-31	$19,084
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	$36,349
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$1,312,845
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,276,496
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$846,562
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,195,323
Interest on participant loans	2020-12-31	$2,562
Interest earned on other investments	2020-12-31	$9,165
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$435,131
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$37,071
Net investment gain/loss from pooled separate accounts	2020-12-31	$116,629
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$180,371
Contract administrator fees	2020-12-31	$10,898
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	MCGOWEN, HURST, CLARK & SMITH, P.C.
Accountancy firm EIN	2020-12-31	421104473
2019 : QHC FACILITIES, LLC 401(K) 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	$335,376
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$299,814
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$287,194
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$92,833
Value of total assets at end of year	2019-12-31	$1,276,496
Value of total assets at beginning of year	2019-12-31	$1,240,934
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$12,620
Total interest from all sources	2019-12-31	$4,922
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$200,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$92,833
Participant contributions at end of year	2019-12-31	$40,999
Participant contributions at beginning of year	2019-12-31	$62,613
Participant contributions at end of year	2019-12-31	$3,103
Participant contributions at beginning of year	2019-12-31	$3,516
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$753
Other income not declared elsewhere	2019-12-31	$2,030
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	$35,562
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,276,496
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,240,934
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	$1,195,323
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,137,160
Interest on participant loans	2019-12-31	$3,732
Interest earned on other investments	2019-12-31	$1,190
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$37,071
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$36,892
Net investment gain/loss from pooled separate accounts	2019-12-31	$235,591
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$287,194
Contract administrator fees	2019-12-31	$12,620
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	MCGOWEN, HURST, CLARK & SMITH, P.C.
Accountancy firm EIN	2019-12-31	421104473
2018 : QHC FACILITIES, LLC 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$44,058
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$352,653
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$340,414
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$101,409
Value of total assets at end of year	2018-12-31	$1,240,934
Value of total assets at beginning of year	2018-12-31	$1,549,529
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$12,239
Total interest from all sources	2018-12-31	$4,103
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$200,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$100,242
Participant contributions at end of year	2018-12-31	$62,613
Participant contributions at beginning of year	2018-12-31	$25,751
Participant contributions at end of year	2018-12-31	$3,516
Participant contributions at beginning of year	2018-12-31	$3,791
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$1,167
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$753
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$516
Other income not declared elsewhere	2018-12-31	$-1,102
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	$-308,595
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,240,934
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,549,529
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	$1,137,160
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$1,484,370
Interest on participant loans	2018-12-31	$2,959
Interest earned on other investments	2018-12-31	$1,144
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$36,892
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$35,101
Net investment gain/loss from pooled separate accounts	2018-12-31	$-60,352
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$340,414
Contract administrator fees	2018-12-31	$12,239
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	MCGOWEN, HURST, CLARK & SMITH, P.C.
Accountancy firm EIN	2018-12-31	421104473
2017 : QHC FACILITIES, LLC 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$331,586
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$533,485
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$523,304
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$113,974
Value of total assets at end of year	2017-12-31	$1,549,529
Value of total assets at beginning of year	2017-12-31	$1,751,428
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$10,181
Total interest from all sources	2017-12-31	$3,157
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$200,000
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	$113,003
Participant contributions at end of year	2017-12-31	$25,751
Participant contributions at beginning of year	2017-12-31	$41,379
Participant contributions at end of year	2017-12-31	$3,791
Participant contributions at beginning of year	2017-12-31	$4,645
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$971
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$516
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$614
Other income not declared elsewhere	2017-12-31	$-348
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	$-201,899
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,549,529
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,751,428
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	$1,484,370
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$1,463,061
Interest on participant loans	2017-12-31	$1,596
Interest earned on other investments	2017-12-31	$1,561
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$35,101
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$241,729
Net investment gain/loss from pooled separate accounts	2017-12-31	$214,803
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	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$523,304
Contract administrator fees	2017-12-31	$10,181
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	MCGOWEN, HURST, CLARK, & SMITH, PC
Accountancy firm EIN	2017-12-31	421140447
2016 : QHC FACILITIES, LLC 401(K) 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	$282,032
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$312,505
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$305,261
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$157,475
Value of total assets at end of year	2016-12-31	$1,751,428
Value of total assets at beginning of year	2016-12-31	$1,781,901
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$7,244
Total interest from all sources	2016-12-31	$6,459
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$200,000
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	$156,856
Participant contributions at end of year	2016-12-31	$41,379
Participant contributions at beginning of year	2016-12-31	$49,189
Participant contributions at end of year	2016-12-31	$4,645
Participant contributions at beginning of year	2016-12-31	$5,985
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$619
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$614
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$1,296
Other income not declared elsewhere	2016-12-31	$2,290
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	$-30,473
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$1,751,428
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,781,901
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$1,463,061
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,468,565
Interest on participant loans	2016-12-31	$2,028
Interest earned on other investments	2016-12-31	$4,431
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$241,729
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$256,866
Net investment gain/loss from pooled separate accounts	2016-12-31	$115,808
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	Yes
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	$305,261
Contract administrator fees	2016-12-31	$7,244
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	MCGOWEN, HURST, CLARK & SMITH, PC
Accountancy firm EIN	2016-12-31	421140447
2015 : QHC FACILITIES, LLC 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$171,801
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$229,358
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$221,164
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$193,976
Value of total assets at end of year	2015-12-31	$1,781,901
Value of total assets at beginning of year	2015-12-31	$1,839,458
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$8,194
Total interest from all sources	2015-12-31	$6,855
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$200,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$193,976
Participant contributions at end of year	2015-12-31	$49,189
Participant contributions at beginning of year	2015-12-31	$92,996
Participant contributions at end of year	2015-12-31	$5,985
Participant contributions at beginning of year	2015-12-31	$8
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$1,296
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$1,904
Other income not declared elsewhere	2015-12-31	$-2,291
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-57,557
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,781,901
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,839,458
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$1,468,565
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$1,493,565
Interest on participant loans	2015-12-31	$3,367
Interest earned on other investments	2015-12-31	$3,488
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$256,866
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$250,985
Net investment gain/loss from pooled separate accounts	2015-12-31	$-26,739
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$221,164
Contract administrator fees	2015-12-31	$8,194
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	MCGOWEN, HURST, CLARK & SMITH, PC
Accountancy firm EIN	2015-12-31	421140447
2014 : QHC FACILITIES, LLC 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$293,224
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$189,382
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$180,447
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$203,241
Value of total assets at end of year	2014-12-31	$1,839,458
Value of total assets at beginning of year	2014-12-31	$1,735,616
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$8,935
Total interest from all sources	2014-12-31	$8,513
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$200,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$198,123
Participant contributions at end of year	2014-12-31	$92,996
Participant contributions at beginning of year	2014-12-31	$90,298
Participant contributions at end of year	2014-12-31	$8
Participant contributions at beginning of year	2014-12-31	$25
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$5,118
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$1,904
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$1,797
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$103,842
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,839,458
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,735,616
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$1,493,565
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$1,413,174
Interest on participant loans	2014-12-31	$3,919
Interest earned on other investments	2014-12-31	$4,594
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$250,985
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$230,322
Net investment gain/loss from pooled separate accounts	2014-12-31	$81,470
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$180,447
Contract administrator fees	2014-12-31	$8,935
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	MCGOWEN, HURST, CLARK & SMITH, PC
Accountancy firm EIN	2014-12-31	421140447
2013 : QHC FACILITIES, LLC 401(K) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$444,929
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$337,083
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$327,692
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$182,168
Value of total assets at end of year	2013-12-31	$1,735,616
Value of total assets at beginning of year	2013-12-31	$1,627,770
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$9,391
Total interest from all sources	2013-12-31	$9,186
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$200,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$182,168
Participant contributions at end of year	2013-12-31	$90,298
Participant contributions at beginning of year	2013-12-31	$110,243
Participant contributions at end of year	2013-12-31	$25
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$1,797
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$1,740
Other income not declared elsewhere	2013-12-31	$-5,609
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$107,846
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$1,735,616
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,627,770
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$1,413,174
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,286,179
Interest on participant loans	2013-12-31	$4,271
Interest earned on other investments	2013-12-31	$4,915
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$230,322
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$229,608
Net investment gain/loss from pooled separate accounts	2013-12-31	$259,184
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$327,692
Contract administrator fees	2013-12-31	$9,391
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	MCGOWEN, HURST, CLARK & SMITH, PC
Accountancy firm EIN	2013-12-31	421140447
2012 : QHC FACILITIES, LLC 401(K) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$372,868
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$157,255
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$149,884
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$226,314
Value of total assets at end of year	2012-12-31	$1,627,770
Value of total assets at beginning of year	2012-12-31	$1,412,157
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$7,371
Total interest from all sources	2012-12-31	$10,611
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$200,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$170,345
Participant contributions at end of year	2012-12-31	$110,243
Participant contributions at beginning of year	2012-12-31	$123,023
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$55,969
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$1,740
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$1,663
Other income not declared elsewhere	2012-12-31	$5,609
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$215,613
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,627,770
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,412,157
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$1,286,179
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$1,287,471
Interest on participant loans	2012-12-31	$4,802
Interest earned on other investments	2012-12-31	$5,809
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$229,608
Net investment gain/loss from pooled separate accounts	2012-12-31	$130,334
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$149,884
Contract administrator fees	2012-12-31	$7,371
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	MCGOWEN, HURST, CLARK & SMITH, PC
Accountancy firm EIN	2012-12-31	421140447
2011 : QHC FACILITIES, LLC 401(K) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$145,847
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$162,154
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$153,028
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$166,961
Value of total assets at end of year	2011-12-31	$1,412,157
Value of total assets at beginning of year	2011-12-31	$1,428,464
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$9,126
Total interest from all sources	2011-12-31	$6,711
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$150,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$155,900
Participant contributions at end of year	2011-12-31	$123,023
Participant contributions at beginning of year	2011-12-31	$40,505
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$11,061
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$1,663
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-16,307
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,412,157
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,428,464
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$1,287,471
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$1,387,959
Interest on participant loans	2011-12-31	$4,346
Interest earned on other investments	2011-12-31	$2,365
Net investment gain/loss from pooled separate accounts	2011-12-31	$-27,825
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$153,028
Contract administrator fees	2011-12-31	$9,126
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	MCGOWEN, HURST, CLARK & SMITH, PC
Accountancy firm EIN	2011-12-31	421140447

Form 5500 Responses for QHC FACILITIES, LLC 401(K) PLAN

2021: QHC FACILITIES, LLC 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
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: QHC FACILITIES, LLC 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: QHC FACILITIES, LLC 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: QHC FACILITIES, LLC 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: QHC FACILITIES, LLC 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: QHC FACILITIES, LLC 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: QHC FACILITIES, LLC 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: QHC FACILITIES, LLC 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: QHC FACILITIES, LLC 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: QHC FACILITIES, LLC 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: QHC FACILITIES, LLC 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

438-00047

Policy instance

Insurance contract or identification number	438-00047
Number of Individuals Covered	87
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

438-00047

Policy instance

Insurance contract or identification number	438-00047
Number of Individuals Covered	98
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

438-00047

Policy instance

Insurance contract or identification number	438-00047
Number of Individuals Covered	112
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

438-00047

Policy instance

Insurance contract or identification number	438-00047
Number of Individuals Covered	140
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

438-00047

Policy instance

Insurance contract or identification number	438-00047
Number of Individuals Covered	141
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,991
Total amount of fees paid to insurance company	USD $998
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,991
Insurance broker organization code?	3
Amount paid for insurance broker fees	998
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker name	PARADIGM BENEFITS LLC

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

438-00047

Policy instance

Insurance contract or identification number	438-00047
Number of Individuals Covered	178
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,974
Total amount of fees paid to insurance company	USD $2,835
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,540
Insurance broker organization code?	3
Amount paid for insurance broker fees	2835
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker name	PARADIGM BENEFITS LLC

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

438-00047

Policy instance

Insurance contract or identification number	438-00047
Number of Individuals Covered	173
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,590
Total amount of fees paid to insurance company	USD $4,876
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,590
Insurance broker organization code?	3
Amount paid for insurance broker fees	4876
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker name	PARADIGM BENEFITS LLC

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

438-00047

Policy instance

Insurance contract or identification number	438-00047
Number of Individuals Covered	187
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,347
Total amount of fees paid to insurance company	USD $4,745
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $8,347
Insurance broker organization code?	3
Amount paid for insurance broker fees	4745
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker name	PARADIGM BENEFITS LLC

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

438-00047

Policy instance

Insurance contract or identification number	438-00047
Number of Individuals Covered	193
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $8,975
Total amount of fees paid to insurance company	USD $5,109
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $8,975
Insurance broker organization code?	3
Amount paid for insurance broker fees	5109
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker name	PARADIGM BENEFITS LLC

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

438-00047

Policy instance

Insurance contract or identification number	438-00047
Number of Individuals Covered	194
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,071
Total amount of fees paid to insurance company	USD $2,965
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	QHC FACILITIES, LLC
Employer identification number (EIN):	262923180
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	Iowa Secretary of State Business Entities
Incorporation Date:	2008-06-27
Company Identification Number:	365469
Legal Registered Office Address:	8350 HICKMAN RD STE 15 DES MOINES United States of America (USA) 50325