401k Plan data: VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN plan

VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN 401k Plan overview

Plan Name	VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN
Plan identification number	001

VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
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.

401k Sponsoring company profile

VICTOR VALLEY HOSPITAL ACQUISITION, INC. DBA has sponsored the creation of one or more 401k plans.

Company Name: VICTOR VALLEY HOSPITAL ACQUISITION, INC. DBA

Employer identification number (EIN): 952475762

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 NAYA VELAZQUEZ
001 2014-01-01 NAYA VELAZQUEZ NAYA VELAZQUEZ 2016-10-13
001 2014-01-01 KEVIN SAUNDERS
001 2013-05-15 KEVIN SAUNDERS

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2015-01-01	NAYA VELAZQUEZ
001	2014-01-01	NAYA VELAZQUEZ	NAYA VELAZQUEZ	2016-10-13
001	2014-01-01	KEVIN SAUNDERS
001	2013-05-15	KEVIN SAUNDERS

Plan Statistics for VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN

401k plan membership statisitcs for VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN

Measure Date Value
2015: VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 843
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 790
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 48
Total of all active and inactive participants 2015-01-01 838
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 838
Number of participants with account balances 2015-01-01 247
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 706
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 824
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 19
Total of all active and inactive participants 2014-01-01 843
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 843
Number of participants with account balances 2014-01-01 227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-05-15 462
Total number of active participants reported on line 7a of the Form 5500 2013-05-15 700
Number of retired or separated participants receiving benefits 2013-05-15 0
Number of other retired or separated participants entitled to future benefits 2013-05-15 6
Total of all active and inactive participants 2013-05-15 706
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-05-15 0
Total participants 2013-05-15 706
Number of participants with account balances 2013-05-15 205
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-05-15 0

Measure	Date	Value
2015: VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	843
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	790
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	48
Total of all active and inactive participants	2015-01-01	838
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	838
Number of participants with account balances	2015-01-01	247
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	706
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	824
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	19
Total of all active and inactive participants	2014-01-01	843
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	843
Number of participants with account balances	2014-01-01	227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-05-15	462
Total number of active participants reported on line 7a of the Form 5500	2013-05-15	700
Number of retired or separated participants receiving benefits	2013-05-15	0
Number of other retired or separated participants entitled to future benefits	2013-05-15	6
Total of all active and inactive participants	2013-05-15	706
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-05-15	0
Total participants	2013-05-15	706
Number of participants with account balances	2013-05-15	205
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-05-15	0

Financial Data on VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN

Measure	Date	Value
2015 : VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$901,527
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$491,178
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$479,848
Expenses. Certain deemed distributions of participant loans	2015-12-31	$697
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$915,805
Value of total assets at end of year	2015-12-31	$4,123,575
Value of total assets at beginning of year	2015-12-31	$3,713,226
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$10,633
Total interest from all sources	2015-12-31	$21,000
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$761,124
Participant contributions at end of year	2015-12-31	$139,654
Participant contributions at beginning of year	2015-12-31	$115,734
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$154,681
Other income not declared elsewhere	2015-12-31	$32
Administrative expenses (other) incurred	2015-12-31	$10,633
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$410,349
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$4,123,575
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$3,713,226
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$3,128,223
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,528,267
Interest on participant loans	2015-12-31	$4,902
Interest earned on other investments	2015-12-31	$16,098
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$855,698
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$1,069,225
Net investment gain/loss from pooled separate accounts	2015-12-31	$-35,310
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$479,848
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	MARCUM LLP
Accountancy firm EIN	2015-12-31	111986323
2014 : VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$936,426
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$115,968
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$103,077
Expenses. Certain deemed distributions of participant loans	2014-12-31	$5,258
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$807,850
Value of total assets at end of year	2014-12-31	$3,713,226
Value of total assets at beginning of year	2014-12-31	$2,892,768
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$7,633
Total interest from all sources	2014-12-31	$21,350
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$300,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$753,638
Participant contributions at end of year	2014-12-31	$115,734
Participant contributions at beginning of year	2014-12-31	$131,013
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$54,212
Other income not declared elsewhere	2014-12-31	$-9,602
Administrative expenses (other) incurred	2014-12-31	$7,633
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$820,458
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$3,713,226
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,892,768
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$2,528,267
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$1,806,924
Interest on participant loans	2014-12-31	$3,859
Interest earned on other investments	2014-12-31	$17,491
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$1,069,225
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$954,831
Net investment gain/loss from pooled separate accounts	2014-12-31	$116,828
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$103,077
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	TCA PARTNERS, LLP
Accountancy firm EIN	2014-12-31	202707086
2013 : VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$2,919,238
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$26,470
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$23,253
Expenses. Certain deemed distributions of participant loans	2013-12-31	$127
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$2,790,100
Value of total assets at end of year	2013-12-31	$2,892,768
Value of total assets at beginning of year	2013-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$3,090
Total interest from all sources	2013-12-31	$11,939
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$300,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$459,239
Participant contributions at end of year	2013-12-31	$131,013
Participant contributions at beginning of year	2013-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$2,330,861
Administrative expenses (other) incurred	2013-12-31	$3,090
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$2,892,768
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,892,768
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$1,806,924
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$0
Interest on participant loans	2013-12-31	$1,616
Interest earned on other investments	2013-12-31	$10,323
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$954,831
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$0
Net investment gain/loss from pooled separate accounts	2013-12-31	$117,199
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$23,253
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	TCA PARTNERS, LLP
Accountancy firm EIN	2013-12-31	202707086

Form 5500 Responses for VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN

2015: VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: VICTOR VALLEY GLOBAL MEDICAL CENTER 401(K) SAVINGS PLAN 2013 form 5500 responses
2013-05-15	Type of plan entity	Single employer plan
2013-05-15	First time form 5500 has been submitted	Yes
2013-05-15	Submission has been amended	No
2013-05-15	This submission is the final filing	No
2013-05-15	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-05-15	Plan is a collectively bargained plan	No
2013-05-15	Plan funding arrangement – Insurance	Yes
2013-05-15	Plan funding arrangement – Trust	Yes
2013-05-15	Plan benefit arrangement – Insurance	Yes
2013-05-15	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

ZH9837

Policy instance

Insurance contract or identification number	ZH9837
Number of Individuals Covered	838
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

ZH9723

Policy instance

Insurance contract or identification number	ZH9723
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-10-13
Total amount of commissions paid to insurance broker	USD $2,597
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,597
Insurance broker organization code?	3
Insurance broker name	INVESTMENT FINANCIAL CORPORATION

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

Policy contract number

ZH9837

Policy instance

Insurance contract or identification number	ZH9837
Number of Individuals Covered	843
Insurance policy start date	2014-10-14
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

ZH9723

Policy instance

Insurance contract or identification number	ZH9723
Number of Individuals Covered	706
Insurance policy start date	2013-05-15
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,403
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,403
Insurance broker organization code?	3
Insurance broker name	INVESTMENT FINANCIAL CORPORATION

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Company Name:	VICTOR VALLEY HOSPITAL ACQUISITION, INC. DBA
Employer identification number (EIN):	952475762
NAIC Classification:	622000
NAIC Description:	Hospitals