401k Plan data: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN plan

MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 401k Plan overview

Plan Name	MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN
Plan identification number	006

MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

MADISON COMMUNITY HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: MADISON COMMUNITY HOSPITAL

Employer identification number (EIN): 460228038

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

Additional information about MADISON COMMUNITY HOSPITAL

Jurisdiction of Incorporation: South Dakota Secretary of State

Incorporation Date:

Company Identification Number: NS000316

More information about MADISON COMMUNITY HOSPITAL

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
006 2022-01-01 TAMARA MILLER 2023-09-27 TERESA MALLETT 2023-09-27
006 2021-01-01 TAMARA MILLER 2022-10-12 TERESA MALLETT 2022-10-12
006 2020-01-01 TAMARA MILLER 2021-10-14 TAMARA MILLER 2021-10-14
006 2019-01-01 TAMARA MILLER 2020-10-14 TAMARA MILLER 2020-10-14
006 2018-01-01 TERESA MALLETT 2019-10-14 TERESA MALLETT 2019-10-14
006 2017-01-01
006 2016-01-01
006 2015-01-01
006 2014-01-01
006 2013-01-01
006 2012-01-01 TAMARA MILLER
006 2011-01-01 TAMARA MILLER
006 2009-01-01 TAMARA MILLER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
006	2022-01-01	TAMARA MILLER	2023-09-27	TERESA MALLETT	2023-09-27
006	2021-01-01	TAMARA MILLER	2022-10-12	TERESA MALLETT	2022-10-12
006	2020-01-01	TAMARA MILLER	2021-10-14	TAMARA MILLER	2021-10-14
006	2019-01-01	TAMARA MILLER	2020-10-14	TAMARA MILLER	2020-10-14
006	2018-01-01	TERESA MALLETT	2019-10-14	TERESA MALLETT	2019-10-14
006	2017-01-01
006	2016-01-01
006	2015-01-01
006	2014-01-01
006	2013-01-01
006	2012-01-01	TAMARA MILLER
006	2011-01-01	TAMARA MILLER
006	2009-01-01	TAMARA MILLER

Plan Statistics for MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN

401k plan membership statisitcs for MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN

Measure Date Value
2022: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 346
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 273
Number of retired or separated participants receiving benefits 2022-01-01 45
Number of other retired or separated participants entitled to future benefits 2022-01-01 33
Total of all active and inactive participants 2022-01-01 351
Total participants 2022-01-01 351
Number of participants with account balances 2022-01-01 274
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 262
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 269
Number of retired or separated participants receiving benefits 2021-01-01 49
Number of other retired or separated participants entitled to future benefits 2021-01-01 28
Total of all active and inactive participants 2021-01-01 346
Total participants 2021-01-01 346
Number of participants with account balances 2021-01-01 270
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 347
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 262
Number of retired or separated participants receiving benefits 2020-01-01 47
Number of other retired or separated participants entitled to future benefits 2020-01-01 36
Total of all active and inactive participants 2020-01-01 345
Total participants 2020-01-01 345
Number of participants with account balances 2020-01-01 261
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 353
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 274
Number of retired or separated participants receiving benefits 2019-01-01 53
Number of other retired or separated participants entitled to future benefits 2019-01-01 20
Total of all active and inactive participants 2019-01-01 347
Total participants 2019-01-01 347
Number of participants with account balances 2019-01-01 268
2018: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 312
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 287
Number of retired or separated participants receiving benefits 2018-01-01 48
Number of other retired or separated participants entitled to future benefits 2018-01-01 18
Total of all active and inactive participants 2018-01-01 353
Total participants 2018-01-01 353
Number of participants with account balances 2018-01-01 164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 39
2017: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 278
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 243
Number of retired or separated participants receiving benefits 2017-01-01 53
Number of other retired or separated participants entitled to future benefits 2017-01-01 16
Total of all active and inactive participants 2017-01-01 312
Total participants 2017-01-01 312
Number of participants with account balances 2017-01-01 247
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 22
2016: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 228
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 233
Number of retired or separated participants receiving benefits 2016-01-01 24
Number of other retired or separated participants entitled to future benefits 2016-01-01 21
Total of all active and inactive participants 2016-01-01 278
Total participants 2016-01-01 278
Number of participants with account balances 2016-01-01 205
2015: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 219
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 220
Number of retired or separated participants receiving benefits 2015-01-01 22
Number of other retired or separated participants entitled to future benefits 2015-01-01 8
Total of all active and inactive participants 2015-01-01 250
Total participants 2015-01-01 250
Number of participants with account balances 2015-01-01 140
2014: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 197
Number of retired or separated participants receiving benefits 2014-01-01 13
Number of other retired or separated participants entitled to future benefits 2014-01-01 9
Total of all active and inactive participants 2014-01-01 219
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 219
Number of participants with account balances 2014-01-01 123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 171
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 156
Number of other retired or separated participants entitled to future benefits 2013-01-01 5
Total of all active and inactive participants 2013-01-01 161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 2
Total participants 2013-01-01 163
Number of participants with account balances 2013-01-01 142
2012: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 156
Number of other retired or separated participants entitled to future benefits 2012-01-01 12
Total of all active and inactive participants 2012-01-01 168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 3
Total participants 2012-01-01 171
Number of participants with account balances 2012-01-01 98
2011: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 162
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 131
Number of other retired or separated participants entitled to future benefits 2011-01-01 8
Total of all active and inactive participants 2011-01-01 139
Total participants 2011-01-01 139
Number of participants with account balances 2011-01-01 95
2009: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 153
Number of other retired or separated participants entitled to future benefits 2009-01-01 3
Total of all active and inactive participants 2009-01-01 156
Total participants 2009-01-01 156
Number of participants with account balances 2009-01-01 92

Measure	Date	Value
2022: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	346
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	273
Number of retired or separated participants receiving benefits	2022-01-01	45
Number of other retired or separated participants entitled to future benefits	2022-01-01	33
Total of all active and inactive participants	2022-01-01	351
Total participants	2022-01-01	351
Number of participants with account balances	2022-01-01	274
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	262
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	269
Number of retired or separated participants receiving benefits	2021-01-01	49
Number of other retired or separated participants entitled to future benefits	2021-01-01	28
Total of all active and inactive participants	2021-01-01	346
Total participants	2021-01-01	346
Number of participants with account balances	2021-01-01	270
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	347
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	262
Number of retired or separated participants receiving benefits	2020-01-01	47
Number of other retired or separated participants entitled to future benefits	2020-01-01	36
Total of all active and inactive participants	2020-01-01	345
Total participants	2020-01-01	345
Number of participants with account balances	2020-01-01	261
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	353
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	274
Number of retired or separated participants receiving benefits	2019-01-01	53
Number of other retired or separated participants entitled to future benefits	2019-01-01	20
Total of all active and inactive participants	2019-01-01	347
Total participants	2019-01-01	347
Number of participants with account balances	2019-01-01	268
2018: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	312
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	287
Number of retired or separated participants receiving benefits	2018-01-01	48
Number of other retired or separated participants entitled to future benefits	2018-01-01	18
Total of all active and inactive participants	2018-01-01	353
Total participants	2018-01-01	353
Number of participants with account balances	2018-01-01	164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	39
2017: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	278
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	243
Number of retired or separated participants receiving benefits	2017-01-01	53
Number of other retired or separated participants entitled to future benefits	2017-01-01	16
Total of all active and inactive participants	2017-01-01	312
Total participants	2017-01-01	312
Number of participants with account balances	2017-01-01	247
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	22
2016: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	228
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	233
Number of retired or separated participants receiving benefits	2016-01-01	24
Number of other retired or separated participants entitled to future benefits	2016-01-01	21
Total of all active and inactive participants	2016-01-01	278
Total participants	2016-01-01	278
Number of participants with account balances	2016-01-01	205
2015: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	219
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	220
Number of retired or separated participants receiving benefits	2015-01-01	22
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	250
Total participants	2015-01-01	250
Number of participants with account balances	2015-01-01	140
2014: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	197
Number of retired or separated participants receiving benefits	2014-01-01	13
Number of other retired or separated participants entitled to future benefits	2014-01-01	9
Total of all active and inactive participants	2014-01-01	219
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	219
Number of participants with account balances	2014-01-01	123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	171
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	156
Number of other retired or separated participants entitled to future benefits	2013-01-01	5
Total of all active and inactive participants	2013-01-01	161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	2
Total participants	2013-01-01	163
Number of participants with account balances	2013-01-01	142
2012: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	156
Number of other retired or separated participants entitled to future benefits	2012-01-01	12
Total of all active and inactive participants	2012-01-01	168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	3
Total participants	2012-01-01	171
Number of participants with account balances	2012-01-01	98
2011: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	162
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	131
Number of other retired or separated participants entitled to future benefits	2011-01-01	8
Total of all active and inactive participants	2011-01-01	139
Total participants	2011-01-01	139
Number of participants with account balances	2011-01-01	95
2009: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	153
Number of other retired or separated participants entitled to future benefits	2009-01-01	3
Total of all active and inactive participants	2009-01-01	156
Total participants	2009-01-01	156
Number of participants with account balances	2009-01-01	92

Financial Data on MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN

Measure	Date	Value
2022 : MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2022 401k financial data
Total income from all sources (including contributions)	2022-12-31	$-229,485
Total of all expenses incurred	2022-12-31	$184,584
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$177,248
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,005,857
Value of total assets at end of year	2022-12-31	$7,956,285
Value of total assets at beginning of year	2022-12-31	$8,370,354
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$7,336
Total interest from all sources	2022-12-31	$83,122
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$946,372
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$59,485
Administrative expenses (other) incurred	2022-12-31	$7,336
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-414,069
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$7,956,285
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$8,370,354
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$5,533,651
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$6,196,867
Interest earned on other investments	2022-12-31	$83,122
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$2,422,634
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$2,173,487
Net investment gain/loss from pooled separate accounts	2022-12-31	$-1,318,464
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$177,248
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2022-12-31	No
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	EIDE BAILLY LLP
Accountancy firm EIN	2022-12-31	450250958
2021 : MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-12-31	$1,851,024
Total of all expenses incurred	2021-12-31	$577,994
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$569,736
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$922,722
Value of total assets at end of year	2021-12-31	$8,370,354
Value of total assets at beginning of year	2021-12-31	$7,097,324
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$8,258
Total interest from all sources	2021-12-31	$76,683
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$896,367
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$26,355
Administrative expenses (other) incurred	2021-12-31	$8,258
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$1,273,030
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$8,370,354
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$7,097,324
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$6,196,867
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$5,333,997
Interest earned on other investments	2021-12-31	$76,683
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$2,173,487
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$1,763,327
Net investment gain/loss from pooled separate accounts	2021-12-31	$851,619
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$569,736
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-12-31	No
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	EIDE BAILLY LLP
Accountancy firm EIN	2021-12-31	450250958
2020 : MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$1,742,399
Total of all expenses incurred	2020-12-31	$231,238
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$223,373
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$825,787
Value of total assets at end of year	2020-12-31	$7,097,324
Value of total assets at beginning of year	2020-12-31	$5,586,163
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$7,865
Total interest from all sources	2020-12-31	$62,862
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$825,335
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$452
Other income not declared elsewhere	2020-12-31	$222
Administrative expenses (other) incurred	2020-12-31	$7,865
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$1,511,161
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$7,097,324
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$5,586,163
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$5,333,997
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$4,335,129
Interest earned on other investments	2020-12-31	$62,862
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$1,763,327
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$1,251,034
Net investment gain/loss from pooled separate accounts	2020-12-31	$853,528
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$223,373
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2020-12-31	No
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	EIDE BAILLY LLP
Accountancy firm EIN	2020-12-31	450250958
2019 : MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$1,626,630
Total income from all sources (including contributions)	2019-12-31	$1,626,630
Total of all expenses incurred	2019-12-31	$186,753
Total of all expenses incurred	2019-12-31	$186,753
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$179,192
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$761,276
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$761,276
Value of total assets at end of year	2019-12-31	$5,586,163
Value of total assets at end of year	2019-12-31	$5,586,163
Value of total assets at beginning of year	2019-12-31	$4,146,286
Value of total assets at beginning of year	2019-12-31	$4,146,286
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$7,561
Total interest from all sources	2019-12-31	$44,472
Total interest from all sources	2019-12-31	$44,472
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$761,276
Contributions received from participants	2019-12-31	$761,276
Administrative expenses (other) incurred	2019-12-31	$7,561
Administrative expenses (other) incurred	2019-12-31	$7,561
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$1,439,877
Value of net income/loss	2019-12-31	$1,439,877
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$5,586,163
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$5,586,163
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,146,286
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,146,286
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$4,335,129
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$4,335,129
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,088,628
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,088,628
Interest earned on other investments	2019-12-31	$44,472
Interest earned on other investments	2019-12-31	$44,472
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,251,034
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,251,034
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,057,658
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,057,658
Net investment gain/loss from pooled separate accounts	2019-12-31	$820,882
Net investment gain/loss from pooled separate accounts	2019-12-31	$820,882
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$179,192
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$179,192
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	No
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	EIDE BAILLY LLP
Accountancy firm name	2019-12-31	EIDE BAILLY LLP
Accountancy firm EIN	2019-12-31	450250958
Accountancy firm EIN	2019-12-31	450250958
2018 : MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$649,783
Total of all expenses incurred	2018-12-31	$245,919
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$239,263
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$846,436
Value of total assets at end of year	2018-12-31	$4,146,286
Value of total assets at beginning of year	2018-12-31	$3,742,422
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$6,656
Total interest from all sources	2018-12-31	$35,273
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	$500,000
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	$709,823
Participant contributions at beginning of year	2018-12-31	$155
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$136,613
Administrative expenses (other) incurred	2018-12-31	$6,656
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	$403,864
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$4,146,286
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$3,742,422
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	$3,088,628
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$2,891,700
Interest earned on other investments	2018-12-31	$35,273
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$1,057,658
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$850,567
Net investment gain/loss from pooled separate accounts	2018-12-31	$-231,926
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$239,263
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	No
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	EIDE BAILLY LLP
Accountancy firm EIN	2018-12-31	450250958
2017 : MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$1,166,224
Total of all expenses incurred	2017-12-31	$372,542
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$367,518
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$677,527
Value of total assets at end of year	2017-12-31	$3,742,422
Value of total assets at beginning of year	2017-12-31	$2,948,740
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$5,024
Total interest from all sources	2017-12-31	$30,308
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	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$677,527
Participant contributions at end of year	2017-12-31	$155
Administrative expenses (other) incurred	2017-12-31	$5,024
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	$793,682
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$3,742,422
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,948,740
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 pooled separate accounts at end of year	2017-12-31	$2,891,700
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$2,191,264
Interest earned on other investments	2017-12-31	$30,308
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$850,567
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$757,476
Net investment gain/loss from pooled separate accounts	2017-12-31	$458,389
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	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$367,518
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	No
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	EIDE BAILLY LLP
Accountancy firm EIN	2017-12-31	450250958
2016 : MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2016 401k financial data
Total income from all sources (including contributions)	2016-12-31	$630,492
Total of all expenses incurred	2016-12-31	$57,911
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$56,211
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$468,255
Value of total assets at end of year	2016-12-31	$2,948,740
Value of total assets at beginning of year	2016-12-31	$2,376,159
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$1,700
Total interest from all sources	2016-12-31	$26,932
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	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$468,255
Administrative expenses (other) incurred	2016-12-31	$1,700
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	$572,581
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,948,740
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$2,376,159
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 pooled separate accounts at end of year	2016-12-31	$2,191,264
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$1,772,455
Interest earned on other investments	2016-12-31	$26,932
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$757,476
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$603,704
Net investment gain/loss from pooled separate accounts	2016-12-31	$135,305
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$56,211
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-12-31	No
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	EIDE BAILLY LLP
Accountancy firm EIN	2016-12-31	450250958
2015 : MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2015 401k financial data
Total income from all sources (including contributions)	2015-12-31	$577,858
Total of all expenses incurred	2015-12-31	$78,768
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$78,768
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$578,841
Value of total assets at end of year	2015-12-31	$2,376,159
Value of total assets at beginning of year	2015-12-31	$1,877,069
Total interest from all sources	2015-12-31	$21,437
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$333,925
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$244,916
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	$499,090
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,376,159
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,877,069
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 pooled separate accounts at end of year	2015-12-31	$1,772,455
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$1,484,460
Interest earned on other investments	2015-12-31	$21,437
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$603,704
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$392,609
Net investment gain/loss from pooled separate accounts	2015-12-31	$-22,420
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$78,768
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	No
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	EIDE BAILLY LLP
Accountancy firm EIN	2015-12-31	450250958
2014 : MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2014 401k financial data
Total income from all sources (including contributions)	2014-12-31	$369,417
Total of all expenses incurred	2014-12-31	$261,265
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$261,265
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$281,483
Value of total assets at end of year	2014-12-31	$1,877,069
Value of total assets at beginning of year	2014-12-31	$1,768,917
Total interest from all sources	2014-12-31	$12,811
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$281,483
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	$108,152
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,877,069
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,768,917
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 pooled separate accounts at end of year	2014-12-31	$1,484,460
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$1,253,938
Interest earned on other investments	2014-12-31	$12,811
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$392,609
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$514,979
Net investment gain/loss from pooled separate accounts	2014-12-31	$75,123
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$261,265
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-12-31	No
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	EIDE BAILLY LLP
Accountancy firm EIN	2014-12-31	450250958
2013 : MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2013 401k financial data
Total income from all sources (including contributions)	2013-12-31	$504,804
Total of all expenses incurred	2013-12-31	$13,881
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$13,881
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$220,700
Value of total assets at end of year	2013-12-31	$1,768,917
Value of total assets at beginning of year	2013-12-31	$1,277,994
Total interest from all sources	2013-12-31	$10,809
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$220,700
Participant contributions at beginning of year	2013-12-31	$6,289
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	$490,923
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$1,768,917
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,277,994
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 pooled separate accounts at end of year	2013-12-31	$1,253,938
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$1,047,098
Interest earned on other investments	2013-12-31	$10,809
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$514,979
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$224,607
Net investment gain/loss from pooled separate accounts	2013-12-31	$273,295
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$13,881
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
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	EIDE BAILLY LLP
Accountancy firm EIN	2013-12-31	450250958
2012 : MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$354,526
Total of all expenses incurred	2012-12-31	$110,076
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$110,076
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$215,858
Value of total assets at end of year	2012-12-31	$1,277,994
Value of total assets at beginning of year	2012-12-31	$1,033,544
Total interest from all sources	2012-12-31	$8,085
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$215,858
Participant contributions at end of year	2012-12-31	$6,289
Participant contributions at beginning of year	2012-12-31	$5,373
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	$244,450
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,277,994
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,033,544
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 pooled separate accounts at end of year	2012-12-31	$1,047,098
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$842,443
Interest earned on other investments	2012-12-31	$8,085
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$224,607
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$185,728
Net investment gain/loss from pooled separate accounts	2012-12-31	$130,583
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$110,076
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
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	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	EIDE BAILLY LLP
Accountancy firm EIN	2012-12-31	450250958
2011 : MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2011 401k financial data
Total income from all sources (including contributions)	2011-12-31	$173,852
Total of all expenses incurred	2011-12-31	$26,185
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$26,185
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$186,057
Value of total assets at end of year	2011-12-31	$1,033,544
Value of total assets at beginning of year	2011-12-31	$885,877
Total interest from all sources	2011-12-31	$6,521
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$186,057
Participant contributions at end of year	2011-12-31	$5,373
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	$147,667
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,033,544
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$885,877
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	$842,443
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$739,949
Interest earned on other investments	2011-12-31	$6,521
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$185,728
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$145,928
Net investment gain/loss from pooled separate accounts	2011-12-31	$-18,726
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$26,185
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
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	EIDE BAILLY, LLP
Accountancy firm EIN	2011-12-31	450250958
2010 : MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$295,657
Total of all expenses incurred	2010-12-31	$54,318
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$54,318
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$200,107
Value of total assets at end of year	2010-12-31	$885,877
Value of total assets at beginning of year	2010-12-31	$644,538
Total interest from all sources	2010-12-31	$5,416
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$200,107
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	$241,339
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$885,877
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$644,538
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	$739,949
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$535,957
Interest earned on other investments	2010-12-31	$5,416
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$145,928
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$108,581
Net investment gain/loss from pooled separate accounts	2010-12-31	$90,134
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$54,318
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
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	EIDE BAILLY, LLP
Accountancy firm EIN	2010-12-31	450250958

Form 5500 Responses for MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN

2022: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
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: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
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: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
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: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
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: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: MADISON COMMUNITY HOSPITAL TAX DEFERRED ANNUITY PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

G62112

Policy instance

Insurance contract or identification number	G62112
Number of Individuals Covered	269
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
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G62112

Policy instance

Insurance contract or identification number	G62112
Number of Individuals Covered	266
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G62112

Policy instance

Insurance contract or identification number	G62112
Number of Individuals Covered	251
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G62112

Policy instance

Insurance contract or identification number	G62112
Number of Individuals Covered	261
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G62112

Policy instance

Insurance contract or identification number	G62112
Number of Individuals Covered	257
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G62112

Policy instance

Insurance contract or identification number	G62112
Number of Individuals Covered	236
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G62112

Policy instance

Insurance contract or identification number	G62112
Number of Individuals Covered	129
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $10,952
Total amount of fees paid to insurance company	USD $7,236
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,952
Insurance broker organization code?	3
Amount paid for insurance broker fees	7236
Insurance broker name	GARDNER & WHITE

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

Policy contract number

G62112

Policy instance

Insurance contract or identification number	G62112
Number of Individuals Covered	114
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,066
Total amount of fees paid to insurance company	USD $1,755
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,066
Insurance broker organization code?	3
Amount paid for insurance broker fees	1755
Insurance broker name	GARDNER & WHITE

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

Policy contract number

G62112

Policy instance

Insurance contract or identification number	G62112
Number of Individuals Covered	142
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,521
Total amount of fees paid to insurance company	USD $1,528
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,695
Insurance broker organization code?	3
Amount paid for insurance broker fees	1528
Insurance broker name	GARDNER & WHITE

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

Policy contract number

G62112

Policy instance

Insurance contract or identification number	G62112
Number of Individuals Covered	98
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,337
Total amount of fees paid to insurance company	USD $1,230
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,337
Insurance broker organization code?	3
Amount paid for insurance broker fees	1230
Insurance broker name	GARDNER & WHITE

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

Policy contract number

G62112

Policy instance

Insurance contract or identification number	G62112
Number of Individuals Covered	95
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,898
Total amount of fees paid to insurance company	USD $990
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 guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

G62112

Policy instance

Insurance contract or identification number	G62112
Number of Individuals Covered	92
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,219
Total amount of fees paid to insurance company	USD $800
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 guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,219
Amount paid for insurance broker fees	800
Insurance broker organization code?	3
Insurance broker name	GARDNER & WHITE

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Company Name:	MADISON COMMUNITY HOSPITAL
Employer identification number (EIN):	460228038
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	South Dakota Secretary of State
Incorporation Date:
Company Identification Number:	NS000316