401k Plan data: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN plan

DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 401k Plan overview

Plan Name	DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN
Plan identification number	001

DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
Covered by PBGC - Plan is covered under the PBGC insurance program (see ERISA section 4021).
Plan covered by PBGC that was terminated and closed out for PBGC purposes - Before the end of the plan year (or a prior plan year), (1) the plan terminated in a standard (or distress) termination and completed the distribution of plan assets in satisfaction of all benefit liabilities (or all ERISA Title IV benefits for distress termination); or (2) a trustee was appointed for a terminated plan pursuant to ERISA section 4042.
Frozen Plan - As of the last day of the plan year, the plan provides that no participant will get any new benefit accrual (whether because of service or compensation).
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

ORRVILLE HOSPITAL FOUNDATION has sponsored the creation of one or more 401k plans.

Company Name: ORRVILLE HOSPITAL FOUNDATION

Employer identification number (EIN): 340733138

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 ADAM LUNTZ
001 2016-01-01
001 2016-01-01
001 2016-01-01
001 2015-01-01 MARCHELLE L. SUPPAN
001 2014-01-01 MATTHEW STEWART
001 2013-01-01 MATTHEW STEWART
001 2012-01-01 MATTHEW STEWART
001 2011-01-01 ADAM LUNTZ
001 2009-01-01 STEVE KNOX

Plan Statistics for DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN

401k plan membership statisitcs for DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN

Measure Date Value
2016: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 173
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
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 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 179
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 81
Number of retired or separated participants receiving benefits 2015-01-01 33
Number of other retired or separated participants entitled to future benefits 2015-01-01 56
Total of all active and inactive participants 2015-01-01 170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 3
Total participants 2015-01-01 173
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 189
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 89
Number of retired or separated participants receiving benefits 2014-01-01 32
Number of other retired or separated participants entitled to future benefits 2014-01-01 57
Total of all active and inactive participants 2014-01-01 178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 1
Total participants 2014-01-01 179
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1
2013: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 196
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 101
Number of retired or separated participants receiving benefits 2013-01-01 29
Number of other retired or separated participants entitled to future benefits 2013-01-01 57
Total of all active and inactive participants 2013-01-01 187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 2
Total participants 2013-01-01 189
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 203
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 107
Number of retired or separated participants receiving benefits 2012-01-01 29
Number of other retired or separated participants entitled to future benefits 2012-01-01 59
Total of all active and inactive participants 2012-01-01 195
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 196
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 4
2011: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 211
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 124
Number of retired or separated participants receiving benefits 2011-01-01 27
Number of other retired or separated participants entitled to future benefits 2011-01-01 51
Total of all active and inactive participants 2011-01-01 202
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 203
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 2
2009: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 234
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 153
Number of retired or separated participants receiving benefits 2009-01-01 28
Number of other retired or separated participants entitled to future benefits 2009-01-01 46
Total of all active and inactive participants 2009-01-01 227
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 4

Measure	Date	Value
2016: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	173
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
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	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	179
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	81
Number of retired or separated participants receiving benefits	2015-01-01	33
Number of other retired or separated participants entitled to future benefits	2015-01-01	56
Total of all active and inactive participants	2015-01-01	170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	3
Total participants	2015-01-01	173
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	189
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	89
Number of retired or separated participants receiving benefits	2014-01-01	32
Number of other retired or separated participants entitled to future benefits	2014-01-01	57
Total of all active and inactive participants	2014-01-01	178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	1
Total participants	2014-01-01	179
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1
2013: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	196
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	101
Number of retired or separated participants receiving benefits	2013-01-01	29
Number of other retired or separated participants entitled to future benefits	2013-01-01	57
Total of all active and inactive participants	2013-01-01	187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	2
Total participants	2013-01-01	189
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	203
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	107
Number of retired or separated participants receiving benefits	2012-01-01	29
Number of other retired or separated participants entitled to future benefits	2012-01-01	59
Total of all active and inactive participants	2012-01-01	195
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	196
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	4
2011: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	211
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	124
Number of retired or separated participants receiving benefits	2011-01-01	27
Number of other retired or separated participants entitled to future benefits	2011-01-01	51
Total of all active and inactive participants	2011-01-01	202
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	203
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	2
2009: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	234
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	153
Number of retired or separated participants receiving benefits	2009-01-01	28
Number of other retired or separated participants entitled to future benefits	2009-01-01	46
Total of all active and inactive participants	2009-01-01	227
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	4

Financial Data on DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN

Measure	Date	Value
2016 : DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-09-30	$2,606
Total income from all sources (including contributions)	2016-09-30	$677,658
Total loss/gain on sale of assets	2016-09-30	$0
Total of all expenses incurred	2016-09-30	$3,033,580
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-09-30	$3,026,940
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-09-30	$675,919
Value of total assets at end of year	2016-09-30	$0
Value of total assets at beginning of year	2016-09-30	$2,358,528
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-09-30	$6,640
Total interest from all sources	2016-09-30	$4,421
Total dividends received (eg from common stock, registered investment company shares)	2016-09-30	$6,817
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-09-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-09-30	$6,640
Total dividends received from registered investment company shares (eg mutual funds)	2016-09-30	$6,817
Was this plan covered by a fidelity bond	2016-09-30	Yes
Value of fidelity bond cover	2016-09-30	$1,000,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2016-09-30	No
Administrative expenses (other) incurred	2016-09-30	$6,640
Liabilities. Value of operating payables at beginning of year	2016-09-30	$2,606
Total non interest bearing cash at beginning of year	2016-09-30	$12,582
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-09-30	No
Value of net income/loss	2016-09-30	$-2,355,922
Value of net assets at end of year (total assets less liabilities)	2016-09-30	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-09-30	$2,355,922
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-09-30	No
Were any leases to which the plan was party in default or uncollectible	2016-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-09-30	$1,628,204
Interest earned on other investments	2016-09-30	$4,421
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-09-30	$717,742
Expenses. Payments to insurance carriers foe the provision of benefits	2016-09-30	$1,519,398
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-09-30	$-9,499
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-09-30	Yes
Was there a failure to transmit to the plan any participant contributions	2016-09-30	No
Has the plan failed to provide any benefit when due under the plan	2016-09-30	No
Contributions received in cash from employer	2016-09-30	$675,919
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-09-30	$1,507,542
Did the plan have assets held for investment	2016-09-30	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	2016-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2016-09-30	Disclaimer
Accountancy firm name	2016-09-30	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2016-09-30	410746749
2015 : DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION 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	$2,606
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$1,448
Total income from all sources (including contributions)	2015-12-31	$96,619
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$232,795
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$232,545
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$57,406
Value of total assets at end of year	2015-12-31	$2,358,528
Value of total assets at beginning of year	2015-12-31	$2,493,546
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$250
Total interest from all sources	2015-12-31	$16,569
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$25,603
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2015-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$25,603
Administrative expenses professional fees incurred	2015-12-31	$250
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
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
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$115
Liabilities. Value of operating payables at end of year	2015-12-31	$2,606
Liabilities. Value of operating payables at beginning of year	2015-12-31	$1,448
Total non interest bearing cash at end of year	2015-12-31	$12,582
Total non interest bearing cash at beginning of year	2015-12-31	$11,487
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	$-136,176
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,355,922
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,492,098
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	$1,628,204
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$1,712,380
Interest earned on other investments	2015-12-31	$16,569
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$717,742
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$755,237
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-2,959
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	Yes
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	$57,406
Employer contributions (assets) at beginning of year	2015-12-31	$14,327
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$232,545
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	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2015-12-31	410746749
2014 : DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION 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	$1,448
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	$203,812
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$192,892
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$192,892
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$82,164
Value of total assets at end of year	2014-12-31	$2,493,546
Value of total assets at beginning of year	2014-12-31	$2,481,178
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total interest from all sources	2014-12-31	$17,465
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$14,792
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2014-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$14,792
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
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
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$115
Liabilities. Value of operating payables at end of year	2014-12-31	$1,448
Total non interest bearing cash at end of year	2014-12-31	$11,487
Total non interest bearing cash at beginning of year	2014-12-31	$8,036
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	$10,920
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,492,098
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,481,178
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	$1,712,380
Interest earned on other investments	2014-12-31	$17,465
Value of interest in common/collective trusts at beginning of year	2014-12-31	$1,714,468
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$755,237
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$733,830
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$-19,587
Net investment gain or loss from common/collective trusts	2014-12-31	$108,978
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	Yes
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
Contributions received in cash from employer	2014-12-31	$82,164
Employer contributions (assets) at end of year	2014-12-31	$14,327
Employer contributions (assets) at beginning of year	2014-12-31	$24,844
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$192,892
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	BRUNER COX, LLC
Accountancy firm EIN	2014-12-31	340641962
2013 : DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION 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	$5
Total income from all sources (including contributions)	2013-12-31	$501,895
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$177,316
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$177,316
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$68,539
Value of total assets at end of year	2013-12-31	$2,481,178
Value of total assets at beginning of year	2013-12-31	$2,156,604
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$0
Total interest from all sources	2013-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$23
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$23
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
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
Liabilities. Value of operating payables at beginning of year	2013-12-31	$5
Total non interest bearing cash at end of year	2013-12-31	$8,036
Total non interest bearing cash at beginning of year	2013-12-31	$7,754
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	$324,579
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,481,178
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,156,599
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 beginning of year	2013-12-31	$61,902
Value of interest in common/collective trusts at end of year	2013-12-31	$1,714,468
Value of interest in common/collective trusts at beginning of year	2013-12-31	$2,086,948
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$733,830
Net investment gain or loss from common/collective trusts	2013-12-31	$433,333
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	Yes
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
Contributions received in cash from employer	2013-12-31	$68,539
Employer contributions (assets) at end of year	2013-12-31	$24,844
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$177,316
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	BRUNER COX, LLC
Accountancy firm EIN	2013-12-31	340641962
2012 : DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION 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	$5
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$5
Total income from all sources (including contributions)	2012-12-31	$374,953
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$131,832
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$131,582
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$144,740
Value of total assets at end of year	2012-12-31	$2,156,604
Value of total assets at beginning of year	2012-12-31	$1,913,483
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$250
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$74
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	$74
Administrative expenses professional fees incurred	2012-12-31	$250
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$225,000
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
Liabilities. Value of operating payables at end of year	2012-12-31	$5
Liabilities. Value of operating payables at beginning of year	2012-12-31	$5
Total non interest bearing cash at end of year	2012-12-31	$7,754
Total non interest bearing cash at beginning of year	2012-12-31	$6,506
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$243,121
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,156,599
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,913,478
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	$61,902
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$58,162
Value of interest in common/collective trusts at end of year	2012-12-31	$2,086,948
Value of interest in common/collective trusts at beginning of year	2012-12-31	$1,804,137
Net investment gain or loss from common/collective trusts	2012-12-31	$230,139
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	Yes
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	$144,740
Employer contributions (assets) at beginning of year	2012-12-31	$44,678
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$131,582
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 : DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION 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	$5
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$6
Total income from all sources (including contributions)	2011-12-31	$89,600
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$155,134
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$155,134
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$84,443
Value of total assets at end of year	2011-12-31	$1,913,483
Value of total assets at beginning of year	2011-12-31	$1,979,018
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$0
Total interest from all sources	2011-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$49
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	$49
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$225,000
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
Liabilities. Value of operating payables at end of year	2011-12-31	$5
Liabilities. Value of operating payables at beginning of year	2011-12-31	$6
Total non interest bearing cash at end of year	2011-12-31	$6,506
Total non interest bearing cash at beginning of year	2011-12-31	$6,119
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	$-65,534
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,913,478
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,979,012
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	$58,162
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$59,005
Value of interest in common/collective trusts at end of year	2011-12-31	$1,804,137
Value of interest in common/collective trusts at beginning of year	2011-12-31	$1,857,406
Net investment gain or loss from common/collective trusts	2011-12-31	$5,108
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
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	$84,443
Employer contributions (assets) at end of year	2011-12-31	$44,678
Employer contributions (assets) at beginning of year	2011-12-31	$56,488
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$155,134
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 : DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION 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	$6
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$10
Total income from all sources (including contributions)	2010-12-31	$288,335
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$337,413
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$337,413
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$58,976
Value of total assets at end of year	2010-12-31	$1,979,018
Value of total assets at beginning of year	2010-12-31	$2,028,100
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$78
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	$78
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$225,000
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
Liabilities. Value of operating payables at end of year	2010-12-31	$6
Liabilities. Value of operating payables at beginning of year	2010-12-31	$10
Total non interest bearing cash at end of year	2010-12-31	$6,119
Total non interest bearing cash at beginning of year	2010-12-31	$6,124
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	$-49,078
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$1,979,012
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,028,090
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	$59,005
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$67,741
Value of interest in common/collective trusts at end of year	2010-12-31	$1,857,406
Value of interest in common/collective trusts at beginning of year	2010-12-31	$1,900,906
Net investment gain or loss from common/collective trusts	2010-12-31	$229,281
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
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	$58,976
Employer contributions (assets) at end of year	2010-12-31	$56,488
Employer contributions (assets) at beginning of year	2010-12-31	$53,329
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$337,413
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 : DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION 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 DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN

2016: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	Yes
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION 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 - Trust	Yes
2014: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION 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 - Trust	Yes
2013: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION 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 - Trust	Yes
2012: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION 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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: DUNLAP COMMUNITY HOSPITAL EMPLOYEES' PENSION 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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

803357

Policy instance

Insurance contract or identification number	803357
Number of Individuals Covered	173
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
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	1
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

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

803357

Policy instance

Insurance contract or identification number	803357
Number of Individuals Covered	179
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
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

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

803357

Policy instance

Insurance contract or identification number	803357
Number of Individuals Covered	189
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
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

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The information provided on this website is not advice, endorsement or recommendation
The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
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Company Name:	ORRVILLE HOSPITAL FOUNDATION
Employer identification number (EIN):	340733138
NAIC Classification:	622000
NAIC Description:	Hospitals

Plan id#	Filing Submission Date	Name of Administrator
001	2016-01-01	ADAM LUNTZ
001	2016-01-01
001	2016-01-01
001	2016-01-01
001	2015-01-01	MARCHELLE L. SUPPAN
001	2014-01-01	MATTHEW STEWART
001	2013-01-01	MATTHEW STEWART
001	2012-01-01	MATTHEW STEWART
001	2011-01-01	ADAM LUNTZ
001	2009-01-01	STEVE KNOX