401k Plan data: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN plan

ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 401k Plan overview

Plan Name	ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN
Plan identification number	004

ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION 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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

MERCY HEALTH CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: MERCY HEALTH CORPORATION

Employer identification number (EIN): 472158680

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
004 2023-01-01
004 2022-01-01
004 2021-01-01
004 2020-01-01
004 2019-01-01
004 2018-01-01
004 2017-01-01 KATHY HARRIS

Plan Statistics for ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN

401k plan membership statisitcs for ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN

Measure Date Value
2023: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 1,661
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 0
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 0
Number of participants with account balances 2023-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 0
2022: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,803
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,061
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 588
Total of all active and inactive participants 2022-01-01 1,649
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 12
Total participants 2022-01-01 1,661
Number of participants with account balances 2022-01-01 1,661
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 39
2021: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 2,004
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,163
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 631
Total of all active and inactive participants 2021-01-01 1,794
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 9
Total participants 2021-01-01 1,803
Number of participants with account balances 2021-01-01 1,803
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 48
2020: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 2,210
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,338
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 660
Total of all active and inactive participants 2020-01-01 1,998
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 6
Total participants 2020-01-01 2,004
Number of participants with account balances 2020-01-01 2,004
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 91
2019: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 2,450
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,601
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 604
Total of all active and inactive participants 2019-01-01 2,205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 5
Total participants 2019-01-01 2,210
Number of participants with account balances 2019-01-01 2,210
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 106
2018: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 2,704
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,761
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 684
Total of all active and inactive participants 2018-01-01 2,446
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 4
Total participants 2018-01-01 2,450
Number of participants with account balances 2018-01-01 2,450
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 106
2017: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 3,225
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,889
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 811
Total of all active and inactive participants 2017-01-01 2,700
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 4
Total participants 2017-01-01 2,704
Number of participants with account balances 2017-01-01 2,668
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 145

Measure	Date	Value
2023: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	1,661
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	0
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	0
Number of participants with account balances	2023-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	0
2022: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,803
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,061
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	588
Total of all active and inactive participants	2022-01-01	1,649
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	12
Total participants	2022-01-01	1,661
Number of participants with account balances	2022-01-01	1,661
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	39
2021: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	2,004
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,163
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	631
Total of all active and inactive participants	2021-01-01	1,794
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	9
Total participants	2021-01-01	1,803
Number of participants with account balances	2021-01-01	1,803
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	48
2020: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	2,210
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,338
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	660
Total of all active and inactive participants	2020-01-01	1,998
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	6
Total participants	2020-01-01	2,004
Number of participants with account balances	2020-01-01	2,004
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	91
2019: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	2,450
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,601
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	604
Total of all active and inactive participants	2019-01-01	2,205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	5
Total participants	2019-01-01	2,210
Number of participants with account balances	2019-01-01	2,210
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	106
2018: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	2,704
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,761
Number of retired or separated participants receiving benefits	2018-01-01	1
Number of other retired or separated participants entitled to future benefits	2018-01-01	684
Total of all active and inactive participants	2018-01-01	2,446
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	4
Total participants	2018-01-01	2,450
Number of participants with account balances	2018-01-01	2,450
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	106
2017: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	3,225
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,889
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	811
Total of all active and inactive participants	2017-01-01	2,700
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	4
Total participants	2017-01-01	2,704
Number of participants with account balances	2017-01-01	2,668
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	145

Financial Data on ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN

Measure	Date	Value
2022 : ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-6,066,535
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$2,153,821
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$2,153,571
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$0
Value of total assets at end of year	2022-12-31	$30,457,992
Value of total assets at beginning of year	2022-12-31	$38,678,348
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$250
Total interest from all sources	2022-12-31	$55,401
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$1,640,536
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$1,640,536
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$10,000,000
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
Assets. Other investments not covered elsewhere at end of year	2022-12-31	$9,044
Assets. Other investments not covered elsewhere at beginning of year	2022-12-31	$123,887
Other income not declared elsewhere	2022-12-31	$-2,836
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	$-8,220,356
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$30,457,992
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$38,678,348
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	$28,121,492
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$36,498,912
Interest earned on other investments	2022-12-31	$55,401
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$2,327,456
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$2,055,549
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-7,759,636
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	$2,153,571
Contract administrator fees	2022-12-31	$250
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	WIPFLI LLP
Accountancy firm EIN	2022-12-31	390758449
2021 : ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$4,819,162
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$3,007,899
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$3,007,649
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$0
Value of total assets at end of year	2021-12-31	$38,678,348
Value of total assets at beginning of year	2021-12-31	$36,867,085
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$250
Total interest from all sources	2021-12-31	$38,766
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$2,725,112
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$2,725,112
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$10,000,000
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
Assets. Other investments not covered elsewhere at end of year	2021-12-31	$123,887
Assets. Other investments not covered elsewhere at beginning of year	2021-12-31	$103,017
Other income not declared elsewhere	2021-12-31	$1,058
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	$1,811,263
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$38,678,348
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$36,867,085
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	$36,498,912
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$34,830,412
Interest earned on other investments	2021-12-31	$38,766
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$2,055,549
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$1,933,656
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$2,054,226
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	$3,007,649
Contract administrator fees	2021-12-31	$250
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	WIPFLI LLP
Accountancy firm EIN	2021-12-31	390758449
2020 : ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$5,429,797
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$2,345,316
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$2,345,216
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$0
Value of total assets at end of year	2020-12-31	$36,867,085
Value of total assets at beginning of year	2020-12-31	$33,782,604
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$100
Total interest from all sources	2020-12-31	$40,446
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$1,247,581
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$1,247,581
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$10,000,000
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
Assets. Other investments not covered elsewhere at end of year	2020-12-31	$103,017
Assets. Other investments not covered elsewhere at beginning of year	2020-12-31	$98,260
Other income not declared elsewhere	2020-12-31	$-2,613
Administrative expenses (other) incurred	2020-12-31	$100
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	$3,084,481
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$36,867,085
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$33,782,604
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	$34,830,412
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$32,279,258
Interest earned on other investments	2020-12-31	$40,446
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$1,933,656
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$1,405,086
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$4,144,383
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	$2,345,216
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	WIPFLI LLP
Accountancy firm EIN	2020-12-31	390758449
2019 : ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$6,204,795
Total income from all sources (including contributions)	2019-12-31	$6,204,795
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$2,371,556
Total of all expenses incurred	2019-12-31	$2,371,556
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$2,371,506
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$2,371,506
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$0
Value of total assets at end of year	2019-12-31	$33,782,604
Value of total assets at end of year	2019-12-31	$33,782,604
Value of total assets at beginning of year	2019-12-31	$29,949,365
Value of total assets at beginning of year	2019-12-31	$29,949,365
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$50
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$50
Total interest from all sources	2019-12-31	$36,721
Total interest from all sources	2019-12-31	$36,721
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$1,311,017
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$1,311,017
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
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$1,311,017
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$1,311,017
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	$10,000,000
Value of fidelity bond cover	2019-12-31	$10,000,000
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
Administrative expenses (other) incurred	2019-12-31	$50
Administrative expenses (other) incurred	2019-12-31	$50
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	$3,833,239
Value of net income/loss	2019-12-31	$3,833,239
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$33,782,604
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$33,782,604
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$29,949,365
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$29,949,365
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	$32,377,518
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$32,377,518
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$28,676,517
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$28,676,517
Interest earned on other investments	2019-12-31	$36,721
Interest earned on other investments	2019-12-31	$36,721
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,405,086
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,405,086
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,272,848
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,272,848
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$4,857,057
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$4,857,057
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	$2,371,506
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$2,371,506
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
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	WIPFLI LLP
Accountancy firm name	2019-12-31	WIPFLI LLP
Accountancy firm EIN	2019-12-31	390758449
Accountancy firm EIN	2019-12-31	390758449
2018 : ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION 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	$-1,549,630
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$2,090,763
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$2,090,713
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$0
Value of total assets at end of year	2018-12-31	$29,949,365
Value of total assets at beginning of year	2018-12-31	$33,589,758
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$50
Total interest from all sources	2018-12-31	$26,711
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$1,336,569
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$1,336,569
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$10,000,000
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
Administrative expenses (other) incurred	2018-12-31	$50
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	$-3,640,393
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$29,949,365
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$33,589,758
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	$28,676,517
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$32,659,022
Interest earned on other investments	2018-12-31	$26,711
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$1,272,848
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$930,736
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-2,912,910
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	$2,090,713
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	WIPFLI LLP
Accountancy firm EIN	2018-12-31	390758449
2017 : ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION 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	$5,588,098
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$3,112,072
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$3,112,698
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$0
Value of total assets at end of year	2017-12-31	$33,589,758
Value of total assets at beginning of year	2017-12-31	$31,113,732
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$-626
Total interest from all sources	2017-12-31	$15,058
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$954,512
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$954,512
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$10,000,000
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
Administrative expenses (other) incurred	2017-12-31	$-626
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	$2,476,026
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$33,589,758
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$31,113,732
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	$32,659,022
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$27,165,834
Interest earned on other investments	2017-12-31	$14,954
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	$256,464
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$256,464
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$104
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$930,736
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$156,701
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$4,618,528
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
Employer contributions (assets) at end of year	2017-12-31	$0
Employer contributions (assets) at beginning of year	2017-12-31	$3,534,733
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$3,112,698
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	WIPFLI LLP
Accountancy firm EIN	2017-12-31	390758449

Form 5500 Responses for ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN

2023: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	Yes
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
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: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
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: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION 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: ROCKFORD HEALTH SYSTEM FIXED CONTRIBUTION 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

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

664138

Policy instance

Insurance contract or identification number	664138
Number of Individuals Covered	1660
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $70,101
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,101
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

611285/806623

Policy instance

Insurance contract or identification number	611285/806623
Number of Individuals Covered	0
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

664138

Policy instance

Insurance contract or identification number	664138
Number of Individuals Covered	1802
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,412
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,412
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

611285/806623

Policy instance

Insurance contract or identification number	611285/806623
Number of Individuals Covered	11
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

664138

Policy instance

Insurance contract or identification number	664138
Number of Individuals Covered	2003
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,407
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,407
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

664138

Policy instance

Insurance contract or identification number	664138
Number of Individuals Covered	2209
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,835
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,835
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	ALLOCATED NON-CASH COMP
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

611285/806623

Policy instance

Insurance contract or identification number	611285/806623
Number of Individuals Covered	12
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

611285/806623

Policy instance

Insurance contract or identification number	611285/806623
Number of Individuals Covered	14
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

664138

Policy instance

Insurance contract or identification number	664138
Number of Individuals Covered	2449
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $72,789
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $72,789
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	ALLOCATED NON-CASH COMP
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

664138

Policy instance

Insurance contract or identification number	664138
Number of Individuals Covered	2669
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $12,188
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,188
Insurance broker organization code?	3
Insurance broker name	REGULUS ADVISORS, LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

611285/806623

Policy instance

Insurance contract or identification number	611285/806623
Number of Individuals Covered	18
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 $98
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	98
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	FIDELITY INVESTMENTS TAX-EXEMPT SVC

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Company Name:	MERCY HEALTH CORPORATION
Employer identification number (EIN):	472158680
NAIC Classification:	622000
NAIC Description:	Hospitals