401k Plan data: LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN plan

LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN
Plan identification number	001

LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

401k Sponsoring company profile

LIVINGSTON COMMUNITY HEALTH has sponsored the creation of one or more 401k plans.

Company Name: LIVINGSTON COMMUNITY HEALTH

Employer identification number (EIN): 941719656

NAIC Classification: 621498
NAIC Description: All Other Outpatient Care Centers

Additional information about LIVINGSTON COMMUNITY HEALTH

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C0604262

More information about LIVINGSTON COMMUNITY HEALTH

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-05-16 ERIN PILOT 2021-12-01
001 2020-05-16 ERIN PILOT 2021-12-01
001 2019-05-16 ERIN PILOT 2021-02-24
001 2018-05-16 JANELLE SHEARS 2019-12-26 JANELLE SHEARS 2019-12-26
001 2018-05-01 JANELLE SHEARS JANELLE SHEARS 2019-03-14
001 2018-05-01
001 2017-05-01
001 2017-05-01
001 2016-05-01
001 2015-05-01 LESLIE MCGOWAN 2017-01-11
001 2015-04-01 LESLIE MCGOWAN 2016-01-26
001 2014-04-01 LESLIE MCGOWAN 2015-10-09
001 2013-04-01 LESLIE MCGOWAN 2015-01-12
001 2012-04-01 LESLIE MCGOWAN 2014-01-28
001 2011-04-01 LESLIE MCGOWAN 2013-01-15
001 2010-04-01 RANDALL KING 2012-01-17
001 2008-04-01 JOHN ALEXANDER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2021-05-16	ERIN PILOT	2021-12-01
001	2020-05-16	ERIN PILOT	2021-12-01
001	2019-05-16	ERIN PILOT	2021-02-24
001	2018-05-16	JANELLE SHEARS	2019-12-26	JANELLE SHEARS	2019-12-26
001	2018-05-01	JANELLE SHEARS		JANELLE SHEARS	2019-03-14
001	2018-05-01
001	2017-05-01
001	2017-05-01
001	2016-05-01
001	2015-05-01	LESLIE MCGOWAN	2017-01-11
001	2015-04-01	LESLIE MCGOWAN	2016-01-26
001	2014-04-01	LESLIE MCGOWAN	2015-10-09
001	2013-04-01	LESLIE MCGOWAN	2015-01-12
001	2012-04-01	LESLIE MCGOWAN	2014-01-28
001	2011-04-01	LESLIE MCGOWAN	2013-01-15
001	2010-04-01	RANDALL KING	2012-01-17
001	2008-04-01	JOHN ALEXANDER

Plan Statistics for LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN

Measure Date Value
2018: LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-05-01 193
Total number of active participants reported on line 7a of the Form 5500 2018-05-01 0
Number of retired or separated participants receiving benefits 2018-05-01 0
Number of other retired or separated participants entitled to future benefits 2018-05-01 77
Total of all active and inactive participants 2018-05-01 77
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-05-01 0
Total participants 2018-05-01 77
Number of participants with account balances 2018-05-01 77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-05-01 0
2017: LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-05-01 191
Total number of active participants reported on line 7a of the Form 5500 2017-05-01 178
Number of retired or separated participants receiving benefits 2017-05-01 0
Number of other retired or separated participants entitled to future benefits 2017-05-01 15
Total of all active and inactive participants 2017-05-01 193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-05-01 0
Total participants 2017-05-01 193
Number of participants with account balances 2017-05-01 77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-05-01 2
2008: LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN 2008 401k membership
Total participants, beginning-of-year 2008-04-01 67
Total number of active participants reported on line 7a of the Form 5500 2008-04-01 61
Number of retired or separated participants receiving benefits 2008-04-01 0
Number of other retired or separated participants entitled to future benefits 2008-04-01 3
Total of all active and inactive participants 2008-04-01 64
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2008-04-01 0
Total participants 2008-04-01 64
Number of participants with account balances 2008-04-01 59
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2008-04-01 2

Measure	Date	Value
2018: LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-05-01	193
Total number of active participants reported on line 7a of the Form 5500	2018-05-01	0
Number of retired or separated participants receiving benefits	2018-05-01	0
Number of other retired or separated participants entitled to future benefits	2018-05-01	77
Total of all active and inactive participants	2018-05-01	77
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-05-01	0
Total participants	2018-05-01	77
Number of participants with account balances	2018-05-01	77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-05-01	0
2017: LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-05-01	191
Total number of active participants reported on line 7a of the Form 5500	2017-05-01	178
Number of retired or separated participants receiving benefits	2017-05-01	0
Number of other retired or separated participants entitled to future benefits	2017-05-01	15
Total of all active and inactive participants	2017-05-01	193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-05-01	0
Total participants	2017-05-01	193
Number of participants with account balances	2017-05-01	77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-05-01	2
2008: LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN 2008 401k membership
Total participants, beginning-of-year	2008-04-01	67
Total number of active participants reported on line 7a of the Form 5500	2008-04-01	61
Number of retired or separated participants receiving benefits	2008-04-01	0
Number of other retired or separated participants entitled to future benefits	2008-04-01	3
Total of all active and inactive participants	2008-04-01	64
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2008-04-01	0
Total participants	2008-04-01	64
Number of participants with account balances	2008-04-01	59
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2008-04-01	2

Financial Data on LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN

Measure	Date	Value
2018 : LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-05-15	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-05-15	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-05-15	$0
Total income from all sources (including contributions)	2018-05-15	$16,316
Total loss/gain on sale of assets	2018-05-15	$0
Total of all expenses incurred	2018-05-15	$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-05-15	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-05-15	$0
Value of total assets at end of year	2018-05-15	$1,774,557
Value of total assets at beginning of year	2018-05-15	$1,758,241
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-05-15	$0
Total interest from all sources	2018-05-15	$115
Total dividends received (eg from common stock, registered investment company shares)	2018-05-15	$41
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-05-15	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2018-05-15	$0
Total dividends received from registered investment company shares (eg mutual funds)	2018-05-15	$41
Was this plan covered by a fidelity bond	2018-05-15	Yes
Value of fidelity bond cover	2018-05-15	$250,000
If this is an individual account plan, was there a blackout period	2018-05-15	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-05-15	$0
Were there any nonexempt tranactions with any party-in-interest	2018-05-15	No
Participant contributions at end of year	2018-05-15	$47,721
Participant contributions at beginning of year	2018-05-15	$48,722
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-05-15	No
Value of net income/loss	2018-05-15	$16,316
Value of net assets at end of year (total assets less liabilities)	2018-05-15	$1,774,557
Value of net assets at beginning of year (total assets less liabilities)	2018-05-15	$1,758,241
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-05-15	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-05-15	No
Were any leases to which the plan was party in default or uncollectible	2018-05-15	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-05-15	$1,721,549
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-05-15	$1,704,239
Interest on participant loans	2018-05-15	$107
Interest earned on other investments	2018-05-15	$2
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-05-15	$3,616
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-05-15	$3,611
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-05-15	$3,611
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-05-15	$6
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-05-15	$1,671
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-05-15	$1,669
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-05-15	$16,160
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-05-15	No
Was there a failure to transmit to the plan any participant contributions	2018-05-15	No
Has the plan failed to provide any benefit when due under the plan	2018-05-15	No
Did the plan have assets held for investment	2018-05-15	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	2018-05-15	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-05-15	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-05-15	Yes
Opinion of an independent qualified public accountant for this plan	2018-05-15	Disclaimer
Accountancy firm name	2018-05-15	MOSS ADAMS, LLP
Accountancy firm EIN	2018-05-15	910189318
Total unrealized appreciation/depreciation of assets	2018-04-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-04-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-04-30	$0
Total income from all sources (including contributions)	2018-04-30	$488,278
Total loss/gain on sale of assets	2018-04-30	$0
Total of all expenses incurred	2018-04-30	$145,065
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-04-30	$138,515
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-04-30	$121,262
Value of total assets at end of year	2018-04-30	$1,758,241
Value of total assets at beginning of year	2018-04-30	$1,415,028
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-04-30	$6,550
Total interest from all sources	2018-04-30	$2,605
Total dividends received (eg from common stock, registered investment company shares)	2018-04-30	$46
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-04-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-04-30	$46
Was this plan covered by a fidelity bond	2018-04-30	Yes
Value of fidelity bond cover	2018-04-30	$250,000
If this is an individual account plan, was there a blackout period	2018-04-30	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-04-30	$0
Were there any nonexempt tranactions with any party-in-interest	2018-04-30	No
Contributions received from participants	2018-04-30	$100,895
Participant contributions at end of year	2018-04-30	$48,722
Participant contributions at beginning of year	2018-04-30	$52,266
Income. Received or receivable in cash from other sources (including rollovers)	2018-04-30	$179,339
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-04-30	No
Value of net income/loss	2018-04-30	$343,213
Value of net assets at end of year (total assets less liabilities)	2018-04-30	$1,758,241
Value of net assets at beginning of year (total assets less liabilities)	2018-04-30	$1,415,028
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-04-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-04-30	No
Were any leases to which the plan was party in default or uncollectible	2018-04-30	No
Investment advisory and management fees	2018-04-30	$1,407
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-04-30	$1,704,239
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-04-30	$1,086,493
Interest on participant loans	2018-04-30	$1,497
Interest earned on other investments	2018-04-30	$347
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-04-30	$3,611
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-04-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-04-30	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-04-30	$761
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-04-30	$1,669
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-04-30	$276,269
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-04-30	$364,365
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-04-30	No
Was there a failure to transmit to the plan any participant contributions	2018-04-30	Yes
Has the plan failed to provide any benefit when due under the plan	2018-04-30	No
Contributions received in cash from employer	2018-04-30	$20,367
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-04-30	$138,515
Contract administrator fees	2018-04-30	$5,143
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	2018-04-30	Yes
Did the plan have assets held for investment	2018-04-30	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	2018-04-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-04-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-04-30	Yes
Opinion of an independent qualified public accountant for this plan	2018-04-30	Disclaimer
Accountancy firm name	2018-04-30	MOSS ADAMS
Accountancy firm EIN	2018-04-30	910189318
2009 : LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN 2009 401k financial data
Total plan liabilities at beginning of year	2009-03-31	$0
Total income from all sources	2009-03-31	$-410,770
Expenses. Total of all expenses incurred	2009-03-31	$19,910
Benefits paid (including direct rollovers)	2009-03-31	$10,148
Total plan assets at end of year	2009-03-31	$1,168,510
Total plan assets at beginning of year	2009-03-31	$1,599,190
Value of fidelity bond covering the plan	2009-03-31	$200,000
Expenses. Other expenses not covered elsewhere	2009-03-31	$9,762
Other income received	2009-03-31	$-410,770
Net income (gross income less expenses)	2009-03-31	$-430,680
Net plan assets at end of year (total assets less liabilities)	2009-03-31	$1,168,510
Net plan assets at beginning of year (total assets less liabilities)	2009-03-31	$1,599,190
Assets. Value of participant loans	2009-03-31	$124,689

Form 5500 Responses for LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN

2018: LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN 2018 form 5500 responses
2018-05-01	Type of plan entity	Single employer plan
2018-05-01	Submission has been amended	No
2018-05-01	This submission is the final filing	No
2018-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2018-05-01	Plan is a collectively bargained plan	No
2018-05-01	Plan funding arrangement – Insurance	Yes
2018-05-01	Plan funding arrangement – Trust	Yes
2018-05-01	Plan benefit arrangement – Insurance	Yes
2018-05-01	Plan benefit arrangement - Trust	Yes
2017: LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN 2017 form 5500 responses
2017-05-01	Type of plan entity	Single employer plan
2017-05-01	Submission has been amended	No
2017-05-01	This submission is the final filing	No
2017-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-05-01	Plan is a collectively bargained plan	No
2017-05-01	Plan funding arrangement – Insurance	Yes
2017-05-01	Plan funding arrangement – Trust	Yes
2017-05-01	Plan benefit arrangement – Insurance	Yes
2017-05-01	Plan benefit arrangement - Trust	Yes
2008: LIVINGSTON COMMUNITY HEALTH SERVICE, INC. PROFIT SHARING PLAN 2008 form 5500 responses
2008-04-01	Type of plan entity	Single employer plan
2008-04-01	Submission has been amended	Yes
2008-04-01	This submission is the final filing	No
2008-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-04-01	Plan is a collectively bargained plan	No
2008-04-01	Plan funding arrangement – Insurance	Yes
2008-04-01	Plan funding arrangement – Trust	Yes
2008-04-01	Plan benefit arrangement – Insurance	Yes
2008-04-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

CUNA MUTUAL GROUP (National Association of Insurance Commissioners NAIC id number: 62626 )

Policy contract number

10443071

Policy instance

Insurance contract or identification number	10443071
Number of Individuals Covered	77
Insurance policy start date	2018-05-01
Insurance policy end date	2018-05-15
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CUNA MUTUAL GROUP (National Association of Insurance Commissioners NAIC id number: 62626 )

Policy contract number

Policy instance

Number of Individuals Covered	193
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CUNA MUTUAL GROUP (National Association of Insurance Commissioners NAIC id number: 62626 )

Policy contract number

10443071

Policy instance

Insurance contract or identification number	10443071
Number of Individuals Covered	193
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

Policy instance

Number of Individuals Covered	0
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	LIVINGSTON COMMUNITY HEALTH
Employer identification number (EIN):	941719656
NAIC Classification:	621498
NAIC Description:	All Other Outpatient Care Centers

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C0604262