401k Plan data: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE plan

HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 401k Plan overview

Plan Name	HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE
Plan identification number	004

HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

HOSPITAL SERVICES GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: HOSPITAL SERVICES GROUP, INC.

Employer identification number (EIN): 431424284

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Additional information about HOSPITAL SERVICES GROUP, INC.

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 2014-02-27

Company Identification Number: 0775062

Legal Registered Office Address: 9300 MARRIN CT

TOANA
United States of America (USA)
23168

More information about HOSPITAL SERVICES GROUP, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
004 2022-01-01
004 2021-01-01
004 2020-01-01 AARON COOPER 2021-07-19 AARON COOPER 2021-07-19
004 2019-01-01 AARON COOPER 2020-06-22 AARON COOPER 2020-06-22
004 2018-01-01 RICHARD ANDERSON 2019-06-28 RICHARD ANDERSON 2019-06-28
004 2017-01-01 RICHARD ANDERSON 2018-06-19 RICHARD ANDERSON 2018-06-19
004 2016-01-01 RICHARD ANDERSON RICHARD ANDERSON 2017-06-12
004 2015-01-01 RICHARD ANDERSON RICHARD ANDERSON 2016-06-21
004 2014-01-01 RICHARD ANDERSON RICHARD ANDERSON 2015-06-29
004 2013-01-01 RICHARD G. ANDERSON 2014-06-24
004 2012-01-01 RICHARD G. ANDERSON 2013-07-11
004 2011-01-01 RICHARD G. ANDERSON 2012-07-18
004 2010-01-01 RICHARD G ANDERSON 2011-07-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
004	2022-01-01
004	2021-01-01
004	2020-01-01	AARON COOPER	2021-07-19	AARON COOPER	2021-07-19
004	2019-01-01	AARON COOPER	2020-06-22	AARON COOPER	2020-06-22
004	2018-01-01	RICHARD ANDERSON	2019-06-28	RICHARD ANDERSON	2019-06-28
004	2017-01-01	RICHARD ANDERSON	2018-06-19	RICHARD ANDERSON	2018-06-19
004	2016-01-01	RICHARD ANDERSON		RICHARD ANDERSON	2017-06-12
004	2015-01-01	RICHARD ANDERSON		RICHARD ANDERSON	2016-06-21
004	2014-01-01	RICHARD ANDERSON		RICHARD ANDERSON	2015-06-29
004	2013-01-01	RICHARD G. ANDERSON	2014-06-24
004	2012-01-01	RICHARD G. ANDERSON	2013-07-11
004	2011-01-01	RICHARD G. ANDERSON	2012-07-18
004	2010-01-01	RICHARD G ANDERSON	2011-07-21

Plan Statistics for HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE

401k plan membership statisitcs for HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE

Measure Date Value
2022: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2022 401k membership
Total participants, beginning-of-year 2022-01-01 51
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 34
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 13
Total of all active and inactive participants 2022-01-01 47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 47
Number of participants with account balances 2022-01-01 47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2021 401k membership
Total participants, beginning-of-year 2021-01-01 49
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 34
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 17
Total of all active and inactive participants 2021-01-01 51
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 51
Number of participants with account balances 2021-01-01 50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2016: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2016 401k membership
Total participants, beginning-of-year 2016-01-01 36
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 33
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 10
Total of all active and inactive participants 2016-01-01 43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 43
Number of participants with account balances 2016-01-01 43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2015 401k membership
Total participants, beginning-of-year 2015-01-01 35
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 28
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 8
Total of all active and inactive participants 2015-01-01 36
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 36
Number of participants with account balances 2015-01-01 36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2014 401k membership
Total participants, beginning-of-year 2014-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 35
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 0
Total of all active and inactive participants 2014-01-01 35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 35
Number of participants with account balances 2014-01-01 35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2022: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2022 401k membership
Total participants, beginning-of-year	2022-01-01	51
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	34
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	13
Total of all active and inactive participants	2022-01-01	47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	47
Number of participants with account balances	2022-01-01	47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2021 401k membership
Total participants, beginning-of-year	2021-01-01	49
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	34
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	17
Total of all active and inactive participants	2021-01-01	51
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	51
Number of participants with account balances	2021-01-01	50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2016: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2016 401k membership
Total participants, beginning-of-year	2016-01-01	36
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	33
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	10
Total of all active and inactive participants	2016-01-01	43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	43
Number of participants with account balances	2016-01-01	43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2015 401k membership
Total participants, beginning-of-year	2015-01-01	35
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	28
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	8
Total of all active and inactive participants	2015-01-01	36
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	36
Number of participants with account balances	2015-01-01	36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2014 401k membership
Total participants, beginning-of-year	2014-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	35
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	0
Total of all active and inactive participants	2014-01-01	35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	35
Number of participants with account balances	2014-01-01	35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE

Measure	Date	Value
2022 : HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2022 401k financial data
Transfers to/from the plan	2022-12-31	$0
Total plan liabilities at end of year	2022-12-31	$0
Total plan liabilities at beginning of year	2022-12-31	$0
Total income from all sources	2022-12-31	$-683,295
Expenses. Total of all expenses incurred	2022-12-31	$2,681,964
Benefits paid (including direct rollovers)	2022-12-31	$2,595,780
Total plan assets at end of year	2022-12-31	$14,644,043
Total plan assets at beginning of year	2022-12-31	$18,009,302
Value of fidelity bond covering the plan	2022-12-31	$500,000
Total contributions received or receivable from participants	2022-12-31	$296,063
Expenses. Other expenses not covered elsewhere	2022-12-31	$0
Contributions received from other sources (not participants or employers)	2022-12-31	$0
Other income received	2022-12-31	$-1,382,449
Noncash contributions received	2022-12-31	$0
Net income (gross income less expenses)	2022-12-31	$-3,365,259
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$14,644,043
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$18,009,302
Total contributions received or receivable from employer(s)	2022-12-31	$403,091
Value of certain deemed distributions of participant loans	2022-12-31	$0
Value of corrective distributions	2022-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$86,184
2021 : HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2021 401k financial data
Transfers to/from the plan	2021-12-31	$0
Total plan liabilities at end of year	2021-12-31	$0
Total plan liabilities at beginning of year	2021-12-31	$0
Total income from all sources	2021-12-31	$2,621,068
Expenses. Total of all expenses incurred	2021-12-31	$1,072,158
Benefits paid (including direct rollovers)	2021-12-31	$1,036,429
Total plan assets at end of year	2021-12-31	$18,009,302
Total plan assets at beginning of year	2021-12-31	$16,460,392
Value of fidelity bond covering the plan	2021-12-31	$500,000
Total contributions received or receivable from participants	2021-12-31	$283,728
Expenses. Other expenses not covered elsewhere	2021-12-31	$0
Contributions received from other sources (not participants or employers)	2021-12-31	$11,637
Other income received	2021-12-31	$1,923,020
Noncash contributions received	2021-12-31	$0
Net income (gross income less expenses)	2021-12-31	$1,548,910
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$18,009,302
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$16,460,392
Total contributions received or receivable from employer(s)	2021-12-31	$402,683
Value of certain deemed distributions of participant loans	2021-12-31	$0
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$35,729
2016 : HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2016 401k financial data
Total income from all sources	2016-12-31	$1,529,290
Expenses. Total of all expenses incurred	2016-12-31	$429,345
Benefits paid (including direct rollovers)	2016-12-31	$395,272
Total plan assets at end of year	2016-12-31	$11,696,826
Total plan assets at beginning of year	2016-12-31	$10,596,881
Total contributions received or receivable from participants	2016-12-31	$256,960
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$5,574
Other income received	2016-12-31	$939,463
Net income (gross income less expenses)	2016-12-31	$1,099,945
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$11,696,826
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$10,596,881
Total contributions received or receivable from employer(s)	2016-12-31	$327,293
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$34,073
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2015 401k financial data
Total income from all sources	2015-12-31	$516,136
Expenses. Total of all expenses incurred	2015-12-31	$586,842
Benefits paid (including direct rollovers)	2015-12-31	$552,497
Total plan assets at end of year	2015-12-31	$10,596,881
Total plan assets at beginning of year	2015-12-31	$10,667,587
Value of fidelity bond covering the plan	2015-12-31	$1,000,000
Total contributions received or receivable from participants	2015-12-31	$267,552
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$23,856
Other income received	2015-12-31	$-74,136
Net income (gross income less expenses)	2015-12-31	$-70,706
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$10,596,881
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$10,667,587
Total contributions received or receivable from employer(s)	2015-12-31	$298,864
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$130
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$34,215
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2014 401k financial data
Total income from all sources	2014-12-31	$1,365,813
Expenses. Total of all expenses incurred	2014-12-31	$3,068,227
Benefits paid (including direct rollovers)	2014-12-31	$3,052,285
Total plan assets at end of year	2014-12-31	$10,667,587
Total plan assets at beginning of year	2014-12-31	$12,370,001
Value of fidelity bond covering the plan	2014-12-31	$1,000,000
Total contributions received or receivable from participants	2014-12-31	$308,419
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$243,730
Other income received	2014-12-31	$496,735
Net income (gross income less expenses)	2014-12-31	$-1,702,414
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$10,667,587
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$12,370,001
Total contributions received or receivable from employer(s)	2014-12-31	$316,929
Value of certain deemed distributions of participant loans	2014-12-31	$75
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$15,867
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0

Form 5500 Responses for HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE

2022: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	This submission is the final filing	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2016: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 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: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 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: HOSPITAL SERVICES GROUP, INC. EMPLOYEES' 401(K) RE 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

Insurance Providers Used on plan

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

Policy contract number

815110

Policy instance

Insurance contract or identification number	815110
Number of Individuals Covered	34
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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
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

815110

Policy instance

Insurance contract or identification number	815110
Number of Individuals Covered	35
Insurance policy start date	2021-11-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

MR 61424

Policy instance

Insurance contract or identification number	MR 61424
Number of Individuals Covered	36
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,129
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 $7,129
Insurance broker organization code?	1
Insurance broker name	AMERITAS INVESTMENT CORP

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

MR 61424

Policy instance

Insurance contract or identification number	MR 61424
Number of Individuals Covered	35
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $356
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 $356
Insurance broker organization code?	1
Insurance broker name	AMERITAS INVESTMENT CORP

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Company Name:	HOSPITAL SERVICES GROUP, INC.
Employer identification number (EIN):	431424284
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	2014-02-27
Company Identification Number:	0775062
Legal Registered Office Address:	9300 MARRIN CT TOANA United States of America (USA) 23168