401k Plan data: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN plan

SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 401k Plan overview

Plan Name	SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN
Plan identification number	005

SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met. Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.

401k Sponsoring company profile

SAMARITAN REGIONAL HEALTH SYSTEM has sponsored the creation of one or more 401k plans.

Company Name: SAMARITAN REGIONAL HEALTH SYSTEM

Employer identification number (EIN): 340714535

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about SAMARITAN REGIONAL HEALTH SYSTEM

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1910-05-26

Company Identification Number: 26509

Legal Registered Office Address: 1636 EAGLE WAY
-
ASHLAND
United States of America (USA)
44805

More information about SAMARITAN REGIONAL HEALTH SYSTEM

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
005 2017-01-01 THOMAS SNOWBERGER
005 2016-01-01 THOMAS SNOWBERGER
005 2015-01-01 ALYCE LEGG
005 2014-01-01 ALYCE LEGG
005 2013-01-01 ALYCE LEGG
005 2012-01-01 ALYCE LEGG
005 2011-01-01 ALYCE LEGG
005 2010-01-01 ALYCE LEGG ALYCE LEGG 2011-10-13
005 2009-01-01 ALYCE LEGG ALYCE LEGG 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
005	2017-01-01	THOMAS SNOWBERGER
005	2016-01-01	THOMAS SNOWBERGER
005	2015-01-01	ALYCE LEGG
005	2014-01-01	ALYCE LEGG
005	2013-01-01	ALYCE LEGG
005	2012-01-01	ALYCE LEGG
005	2011-01-01	ALYCE LEGG
005	2010-01-01	ALYCE LEGG	ALYCE LEGG	2011-10-13
005	2009-01-01	ALYCE LEGG	ALYCE LEGG	2010-10-14

Plan Statistics for SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN

401k plan membership statisitcs for SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN

Measure Date Value
2017: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 866
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 0
Number of participants with account balances 2017-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 803
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 732
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 134
Total of all active and inactive participants 2016-01-01 866
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 866
Number of participants with account balances 2016-01-01 851
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 2
2015: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 826
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 721
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 119
Total of all active and inactive participants 2015-01-01 840
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 840
Number of participants with account balances 2015-01-01 803
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 802
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 671
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 143
Total of all active and inactive participants 2014-01-01 814
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 814
Number of participants with account balances 2014-01-01 801
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 809
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 720
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 80
Total of all active and inactive participants 2013-01-01 800
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 800
Number of participants with account balances 2013-01-01 738
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 851
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 731
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 78
Total of all active and inactive participants 2012-01-01 810
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 811
Number of participants with account balances 2012-01-01 755
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 832
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 723
Number of retired or separated participants receiving benefits 2011-01-01 1
Number of other retired or separated participants entitled to future benefits 2011-01-01 123
Total of all active and inactive participants 2011-01-01 847
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 847
Number of participants with account balances 2011-01-01 790
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 840
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 779
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 62
Total of all active and inactive participants 2010-01-01 841
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 841
Number of participants with account balances 2010-01-01 770
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 859
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 906
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 122
Total of all active and inactive participants 2009-01-01 1,028
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 1,028
Number of participants with account balances 2009-01-01 952
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2017: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	866
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	0
Number of participants with account balances	2017-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	803
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	732
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	134
Total of all active and inactive participants	2016-01-01	866
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	866
Number of participants with account balances	2016-01-01	851
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	2
2015: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	826
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	721
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	119
Total of all active and inactive participants	2015-01-01	840
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	840
Number of participants with account balances	2015-01-01	803
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	802
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	671
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	143
Total of all active and inactive participants	2014-01-01	814
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	814
Number of participants with account balances	2014-01-01	801
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	809
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	720
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	80
Total of all active and inactive participants	2013-01-01	800
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	800
Number of participants with account balances	2013-01-01	738
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	851
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	731
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	78
Total of all active and inactive participants	2012-01-01	810
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	811
Number of participants with account balances	2012-01-01	755
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	832
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	723
Number of retired or separated participants receiving benefits	2011-01-01	1
Number of other retired or separated participants entitled to future benefits	2011-01-01	123
Total of all active and inactive participants	2011-01-01	847
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	847
Number of participants with account balances	2011-01-01	790
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	840
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	779
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	62
Total of all active and inactive participants	2010-01-01	841
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	841
Number of participants with account balances	2010-01-01	770
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	859
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	906
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	122
Total of all active and inactive participants	2009-01-01	1,028
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	1,028
Number of participants with account balances	2009-01-01	952
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN

Measure	Date	Value
2017 : SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-11-01	$0
Total transfer of assets from this plan	2017-11-01	$39,501,433
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-11-01	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-11-01	$0
Total income from all sources (including contributions)	2017-11-01	$5,092,862
Total loss/gain on sale of assets	2017-11-01	$0
Total of all expenses incurred	2017-11-01	$7,613,451
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-11-01	$7,484,208
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-11-01	$0
Value of total assets at end of year	2017-11-01	$0
Value of total assets at beginning of year	2017-11-01	$42,022,022
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-11-01	$129,243
Total interest from all sources	2017-11-01	$55,452
Total dividends received (eg from common stock, registered investment company shares)	2017-11-01	$180,846
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-11-01	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2017-11-01	$0
Total dividends received from registered investment company shares (eg mutual funds)	2017-11-01	$180,846
Administrative expenses professional fees incurred	2017-11-01	$129,243
Was this plan covered by a fidelity bond	2017-11-01	Yes
Value of fidelity bond cover	2017-11-01	$1,000,000
If this is an individual account plan, was there a blackout period	2017-11-01	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-11-01	$0
Were there any nonexempt tranactions with any party-in-interest	2017-11-01	No
Participant contributions at end of year	2017-11-01	$0
Participant contributions at beginning of year	2017-11-01	$1,468,775
Other income not declared elsewhere	2017-11-01	$102,740
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-11-01	No
Value of net income/loss	2017-11-01	$-2,520,589
Value of net assets at end of year (total assets less liabilities)	2017-11-01	$0
Value of net assets at beginning of year (total assets less liabilities)	2017-11-01	$42,022,022
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-11-01	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-11-01	No
Were any leases to which the plan was party in default or uncollectible	2017-11-01	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-11-01	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-11-01	$28,930,794
Value of interest in pooled separate accounts at end of year	2017-11-01	$0
Value of interest in pooled separate accounts at beginning of year	2017-11-01	$1,350,158
Interest on participant loans	2017-11-01	$55,452
Value of interest in common/collective trusts at end of year	2017-11-01	$0
Value of interest in common/collective trusts at beginning of year	2017-11-01	$10,272,295
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-11-01	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-11-01	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-11-01	$4,413,205
Net investment gain/loss from pooled separate accounts	2017-11-01	$172,812
Net investment gain or loss from common/collective trusts	2017-11-01	$167,807
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-11-01	No
Was there a failure to transmit to the plan any participant contributions	2017-11-01	No
Has the plan failed to provide any benefit when due under the plan	2017-11-01	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-11-01	$7,484,208
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	2017-11-01	Yes
Did the plan have assets held for investment	2017-11-01	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-11-01	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-11-01	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-11-01	Yes
Opinion of an independent qualified public accountant for this plan	2017-11-01	Disclaimer
Accountancy firm name	2017-11-01	KPMG, LLC
Accountancy firm EIN	2017-11-01	135565207
2016 : SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT 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	$6,216,562
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$2,534,567
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$2,405,411
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$3,619,834
Value of total assets at end of year	2016-12-31	$42,022,022
Value of total assets at beginning of year	2016-12-31	$38,340,027
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$129,156
Total interest from all sources	2016-12-31	$72,346
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$344,291
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$344,291
Administrative expenses professional fees incurred	2016-12-31	$99,409
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	Yes
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	$2,459,137
Participant contributions at end of year	2016-12-31	$1,468,775
Participant contributions at beginning of year	2016-12-31	$1,595,517
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$236,705
Other income not declared elsewhere	2016-12-31	$114,502
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	$3,681,995
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$42,022,022
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$38,340,027
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Investment advisory and management fees	2016-12-31	$13,227
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$28,930,794
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$25,360,092
Value of interest in pooled separate accounts at end of year	2016-12-31	$1,350,158
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$735,679
Interest on participant loans	2016-12-31	$72,346
Value of interest in common/collective trusts at end of year	2016-12-31	$10,272,295
Value of interest in common/collective trusts at beginning of year	2016-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$10,648,739
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$1,807,569
Net investment gain/loss from pooled separate accounts	2016-12-31	$57,328
Net investment gain or loss from common/collective trusts	2016-12-31	$200,692
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$923,992
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$2,405,411
Contract administrator fees	2016-12-31	$16,520
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	2016-12-31	Yes
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	KPMG, LLC
Accountancy firm EIN	2016-12-31	135565207
2015 : SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2015-12-31	$216,939
Total unrealized appreciation/depreciation of assets	2015-12-31	$216,939
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	$3,192,943
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$2,515,492
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$2,442,655
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$3,258,088
Value of total assets at end of year	2015-12-31	$38,340,027
Value of total assets at beginning of year	2015-12-31	$37,662,576
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$72,837
Total interest from all sources	2015-12-31	$69,719
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$308,610
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$308,610
Administrative expenses professional fees incurred	2015-12-31	$43,402
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	Yes
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	$2,269,512
Participant contributions at end of year	2015-12-31	$1,595,517
Participant contributions at beginning of year	2015-12-31	$1,473,505
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$142,052
Other income not declared elsewhere	2015-12-31	$86,451
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	$677,451
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$38,340,027
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$37,662,576
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
Investment advisory and management fees	2015-12-31	$14,543
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$25,360,092
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$24,651,992
Value of interest in pooled separate accounts at end of year	2015-12-31	$735,679
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$751,180
Interest on participant loans	2015-12-31	$69,702
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$17
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$10,648,739
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$10,785,899
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-750,857
Net investment gain/loss from pooled separate accounts	2015-12-31	$3,993
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
Contributions received in cash from employer	2015-12-31	$846,524
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$2,442,655
Contract administrator fees	2015-12-31	$14,892
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	2015-12-31	Yes
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	PLANTE & MORAN, PLLC
Accountancy firm EIN	2015-12-31	381357951
2014 : SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$146,393
Total unrealized appreciation/depreciation of assets	2014-12-31	$146,393
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	$4,296,877
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$2,142,036
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$2,080,704
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$2,831,478
Value of total assets at end of year	2014-12-31	$37,662,576
Value of total assets at beginning of year	2014-12-31	$35,507,735
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$61,332
Total interest from all sources	2014-12-31	$67,045
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$543,444
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$543,444
Administrative expenses professional fees incurred	2014-12-31	$24,988
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$1,964,028
Participant contributions at end of year	2014-12-31	$1,473,505
Participant contributions at beginning of year	2014-12-31	$1,427,297
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$130,506
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	$2,154,841
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$37,662,576
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$35,507,735
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
Investment advisory and management fees	2014-12-31	$25,855
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$24,651,992
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$0
Value of interest in pooled separate accounts at end of year	2014-12-31	$751,180
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$26,744,613
Interest on participant loans	2014-12-31	$67,031
Income. Interest from US Government securities	2014-12-31	$14
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$10,785,899
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$7,335,825
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$676,301
Net investment gain/loss from pooled separate accounts	2014-12-31	$32,216
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	Yes
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$736,944
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$2,080,704
Contract administrator fees	2014-12-31	$10,489
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	2014-12-31	Yes
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2014-12-31	381357951
2013 : SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT 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	$7,235,851
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$2,013,021
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$2,003,798
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$2,280,761
Value of total assets at end of year	2013-12-31	$35,507,735
Value of total assets at beginning of year	2013-12-31	$30,284,905
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$9,223
Total interest from all sources	2013-12-31	$354,656
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	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$1,573,410
Participant contributions at end of year	2013-12-31	$1,427,297
Participant contributions at beginning of year	2013-12-31	$1,287,747
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$51,236
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	$5,222,830
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$35,507,735
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$30,284,905
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	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$22,058,017
Value of interest in pooled separate accounts at end of year	2013-12-31	$26,744,613
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$0
Interest on participant loans	2013-12-31	$61,794
Interest earned on other investments	2013-12-31	$292,862
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$7,335,825
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$6,939,141
Net investment gain/loss from pooled separate accounts	2013-12-31	$4,600,434
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	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$656,115
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$2,003,798
Contract administrator fees	2013-12-31	$9,223
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2013-12-31	381357951
2012 : SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT 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	$5,618,869
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$1,075,569
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$1,073,381
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$2,582,837
Value of total assets at end of year	2012-12-31	$30,284,905
Value of total assets at beginning of year	2012-12-31	$25,741,605
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$2,188
Total interest from all sources	2012-12-31	$50,321
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$237,526
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$237,526
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$1,658,057
Participant contributions at end of year	2012-12-31	$1,287,747
Participant contributions at beginning of year	2012-12-31	$977,588
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$92,905
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	$4,543,300
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$30,284,905
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$25,741,605
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	$22,058,017
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$19,247,082
Interest on participant loans	2012-12-31	$50,321
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$6,939,141
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$5,516,935
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$2,748,185
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
Contributions received in cash from employer	2012-12-31	$831,875
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$1,073,381
Contract administrator fees	2012-12-31	$2,188
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2012-12-31	381357951
2011 : SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT 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	$2,324,881
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$815,853
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$758,298
Expenses. Certain deemed distributions of participant loans	2011-12-31	$46,137
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$2,589,831
Value of total assets at end of year	2011-12-31	$25,741,605
Value of total assets at beginning of year	2011-12-31	$24,232,577
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$11,418
Total interest from all sources	2011-12-31	$41,011
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$200,929
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$200,929
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$1,572,012
Participant contributions at end of year	2011-12-31	$977,588
Participant contributions at beginning of year	2011-12-31	$765,242
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$218,297
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	$1,509,028
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$25,741,605
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$24,232,577
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$19,247,082
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$18,731,528
Interest on participant loans	2011-12-31	$41,011
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$5,516,935
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$4,735,807
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-506,890
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
Contributions received in cash from employer	2011-12-31	$799,522
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$758,298
Contract administrator fees	2011-12-31	$11,418
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	PLANTE & MORAN PLLC
Accountancy firm EIN	2011-12-31	381357951
2010 : SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$5,038,601
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$772,518
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$757,575
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$2,346,193
Value of total assets at end of year	2010-12-31	$24,232,577
Value of total assets at beginning of year	2010-12-31	$19,966,494
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$14,943
Total interest from all sources	2010-12-31	$36,985
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$181,355
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$181,355
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$1,527,456
Participant contributions at end of year	2010-12-31	$765,242
Participant contributions at beginning of year	2010-12-31	$551,805
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$53,209
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$4,266,083
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$24,232,577
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$19,966,494
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$18,731,528
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$15,128,690
Interest on participant loans	2010-12-31	$36,985
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$4,735,807
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$4,285,999
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$2,474,068
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$765,528
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$757,575
Contract administrator fees	2010-12-31	$14,943
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	PLANTE & MORAN PLLC
Accountancy firm EIN	2010-12-31	381357951
2009 : SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN

2017: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT 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	Yes
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT 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: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT 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: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT 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: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT 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: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT 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: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT 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
2010: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: SAMARITAN REGIONAL HEALTH SYSTEM MATCHED FUND RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

082173

Policy instance

Insurance contract or identification number	082173
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-11-01
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	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

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

082173

Policy instance

Insurance contract or identification number	082173
Number of Individuals Covered	98
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G62131

Policy instance

Insurance contract or identification number	G62131
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-01-14
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

082173

Policy instance

Insurance contract or identification number	082173
Number of Individuals Covered	97
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G62131

Policy instance

Insurance contract or identification number	G62131
Number of Individuals Covered	738
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

082173

Policy instance

Insurance contract or identification number	082173
Number of Individuals Covered	97
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $199
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $199
Insurance broker organization code?	3
Insurance broker name	G & W EQUITY SALES INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G62131

Policy instance

Insurance contract or identification number	G62131
Number of Individuals Covered	755
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

082173

Policy instance

Insurance contract or identification number	082173
Number of Individuals Covered	0
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $744
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $744
Insurance broker organization code?	3
Insurance broker name	G & W EQUITY SALES INC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G62131

Policy instance

Insurance contract or identification number	G62131
Number of Individuals Covered	790
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

082173

Policy instance

Insurance contract or identification number	082173
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $788
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

082173

Policy instance

Insurance contract or identification number	082173
Number of Individuals Covered	0
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G62131

Policy instance

Insurance contract or identification number	G62131
Number of Individuals Covered	905
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $59,734
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SAMARITAN REGIONAL HEALTH SYSTEM
Employer identification number (EIN):	340714535
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1910-05-26
Company Identification Number:	26509
Legal Registered Office Address:	1636 EAGLE WAY - ASHLAND United States of America (USA) 44805