401k Plan data: RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN plan

RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN 401k Plan overview

Plan Name	RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN
Plan identification number	001

RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

RIVERSIDE HEALTH OF MARYLAND, INC. has sponsored the creation of one or more 401k plans.

Company Name: RIVERSIDE HEALTH OF MARYLAND, INC.

Employer identification number (EIN): 452815803

NAIC Classification: 621491
NAIC Description: HMO Medical Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2018-01-01 MATTHEW YANCISIN MATTHEW YANCISIN 2019-06-06
001 2017-01-01 MATTHEW YANCISIN MATTHEW YANCISIN 2018-05-08
001 2016-01-01 MATTHEW YANCISIN MATTHEW YANCISIN 2017-07-20
001 2015-01-01 MATTHEW YANCISIN 2016-08-24 MATTHEW YANCISIN 2016-08-24
001 2014-01-01 MATTHEW YANCISIN 2015-07-22 MATTHEW YANCISIN 2015-07-22
001 2013-01-01 MATTHEW YANCISIN 2014-03-21 MATTHEW YANCISIN 2014-03-21
001 2012-01-01 MATTHEW YANCISIN 2013-06-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2018-01-01	MATTHEW YANCISIN		MATTHEW YANCISIN	2019-06-06
001	2017-01-01	MATTHEW YANCISIN		MATTHEW YANCISIN	2018-05-08
001	2016-01-01	MATTHEW YANCISIN		MATTHEW YANCISIN	2017-07-20
001	2015-01-01	MATTHEW YANCISIN	2016-08-24	MATTHEW YANCISIN	2016-08-24
001	2014-01-01	MATTHEW YANCISIN	2015-07-22	MATTHEW YANCISIN	2015-07-22
001	2013-01-01	MATTHEW YANCISIN	2014-03-21	MATTHEW YANCISIN	2014-03-21
001	2012-01-01	MATTHEW YANCISIN	2013-06-13

Plan Statistics for RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN

401k plan membership statisitcs for RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN

Measure Date Value
2018: RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 290
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 231
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 54
Total of all active and inactive participants 2018-01-01 285
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 285
Number of participants with account balances 2018-01-01 206
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 219
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 234
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 52
Total of all active and inactive participants 2017-01-01 286
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 286
Number of participants with account balances 2017-01-01 202
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 177
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 31
Total of all active and inactive participants 2016-01-01 208
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 208
Number of participants with account balances 2016-01-01 140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0

Measure	Date	Value
2018: RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	290
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	231
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	54
Total of all active and inactive participants	2018-01-01	285
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	285
Number of participants with account balances	2018-01-01	206
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	219
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	234
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	52
Total of all active and inactive participants	2017-01-01	286
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	286
Number of participants with account balances	2017-01-01	202
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	177
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	31
Total of all active and inactive participants	2016-01-01	208
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	208
Number of participants with account balances	2016-01-01	140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0

Financial Data on RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN

Measure	Date	Value
2018 : RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$1,081,694
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$317,314
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$307,767
Expenses. Certain deemed distributions of participant loans	2018-12-31	$3,091
Value of total corrective distributions	2018-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$1,424,669
Value of total assets at end of year	2018-12-31	$4,839,707
Value of total assets at beginning of year	2018-12-31	$4,075,327
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$6,456
Total interest from all sources	2018-12-31	$4,877
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$600,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$813,832
Participant contributions at end of year	2018-12-31	$107,883
Participant contributions at beginning of year	2018-12-31	$29,566
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$18
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$125,415
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$764,380
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$4,839,707
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$4,075,327
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$4,666,905
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$4,006,470
Interest on participant loans	2018-12-31	$4,877
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$24,623
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$3,575
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-347,852
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$485,422
Employer contributions (assets) at end of year	2018-12-31	$40,296
Employer contributions (assets) at beginning of year	2018-12-31	$35,698
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$307,767
Contract administrator fees	2018-12-31	$6,456
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	CLIFTON LARSON ALLEN LLP
Accountancy firm EIN	2018-12-31	410746749
2017 : RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$1,796,752
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$263,596
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$258,648
Expenses. Certain deemed distributions of participant loans	2017-12-31	$0
Value of total corrective distributions	2017-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,267,855
Value of total assets at end of year	2017-12-31	$4,075,327
Value of total assets at beginning of year	2017-12-31	$2,542,171
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$4,948
Total interest from all sources	2017-12-31	$1,065
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$600,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$679,106
Participant contributions at end of year	2017-12-31	$29,566
Participant contributions at beginning of year	2017-12-31	$14,891
Participant contributions at end of year	2017-12-31	$18
Participant contributions at beginning of year	2017-12-31	$80
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$183,504
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$1,533,156
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$4,075,327
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,542,171
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$4,006,470
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$2,483,463
Interest on participant loans	2017-12-31	$1,070
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$852
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$852
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$-5
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$3,575
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$1,416
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$527,832
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$405,245
Employer contributions (assets) at end of year	2017-12-31	$35,698
Employer contributions (assets) at beginning of year	2017-12-31	$41,469
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$258,648
Contract administrator fees	2017-12-31	$4,948
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	CLIFTON LARSON ALLEN LLP
Accountancy firm EIN	2017-12-31	410746749
2016 : RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$1,389,854
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$420,707
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$416,538
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$1,237,655
Value of total assets at end of year	2016-12-31	$2,542,171
Value of total assets at beginning of year	2016-12-31	$1,573,024
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$4,169
Total interest from all sources	2016-12-31	$615
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$600,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$597,958
Participant contributions at end of year	2016-12-31	$14,891
Participant contributions at beginning of year	2016-12-31	$14,039
Participant contributions at end of year	2016-12-31	$80
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$224,566
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	$969,147
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,542,171
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,573,024
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$2,483,463
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,558,729
Interest on participant loans	2016-12-31	$618
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$852
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$256
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$256
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$-3
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$1,416
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$151,584
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$415,131
Employer contributions (assets) at end of year	2016-12-31	$41,469
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$416,538
Contract administrator fees	2016-12-31	$4,169
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	CLIFTON LARSON ALLEN LLP
Accountancy firm EIN	2016-12-31	410746749

Form 5500 Responses for RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN

2018: RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: RIVERSIDE HEALTH OF MARYLAND, INC. 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

GAP-CP-JK0Z

Policy instance

Insurance contract or identification number	GAP-CP-JK0Z
Number of Individuals Covered	4
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $83
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $83
Insurance broker organization code?	3

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

Policy contract number

GAP-CP-JK0Z

Policy instance

Insurance contract or identification number	GAP-CP-JK0Z
Number of Individuals Covered	3
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $14
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $14
Insurance broker organization code?	3
Insurance broker name	MORGAN STANLEY SMITH BARNEY LLC

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Company Name:	RIVERSIDE HEALTH OF MARYLAND, INC.
Employer identification number (EIN):	452815803
NAIC Classification:	621491
NAIC Description:	HMO Medical Centers