401k Plan data: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN plan

CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 401k Plan overview

Plan Name	CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN
Plan identification number	001

CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) 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.

401k Sponsoring company profile

CHAMPLAIN VALLEY HEALTH NETWORK, INC. has sponsored the creation of one or more 401k plans.

Company Name: CHAMPLAIN VALLEY HEALTH NETWORK, INC.

Employer identification number (EIN): 161586102

NAIC Classification: 561110
NAIC Description: Office Administrative Services

Additional information about CHAMPLAIN VALLEY HEALTH NETWORK, INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1996-10-24

Company Identification Number: 2078070

Legal Registered Office Address: 75 BEEKMAN STREET
Clinton
PLATTSBURGH
United States of America (USA)
12901

More information about CHAMPLAIN VALLEY HEALTH NETWORK, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 MATTHEW LYMAN 2017-10-16 MATTHEW LYMAN 2017-10-16
001 2015-01-01 ROXANNE VASQUEZ ROXANNE VASQUEZ 2016-10-07
001 2014-01-01 ROXANNE VASQUEZ STEPHENS MUNDY 2015-10-15
001 2013-01-01 ROXANNE VASQUEZ STEPHENS MUNDY 2014-10-08
001 2012-01-01 STEPHENS MUNDY STEPHENS MUNDY 2013-10-15
001 2011-01-01 STEPHENS MUNDY STEPHENS MUNDY 2012-10-15
001 2010-01-01 STEPHENS MUNDY 2011-06-21 STEPHENS MUNDY 2011-06-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	MATTHEW LYMAN	2017-10-16	MATTHEW LYMAN	2017-10-16
001	2015-01-01	ROXANNE VASQUEZ		ROXANNE VASQUEZ	2016-10-07
001	2014-01-01	ROXANNE VASQUEZ		STEPHENS MUNDY	2015-10-15
001	2013-01-01	ROXANNE VASQUEZ		STEPHENS MUNDY	2014-10-08
001	2012-01-01	STEPHENS MUNDY		STEPHENS MUNDY	2013-10-15
001	2011-01-01	STEPHENS MUNDY		STEPHENS MUNDY	2012-10-15
001	2010-01-01	STEPHENS MUNDY	2011-06-21	STEPHENS MUNDY	2011-06-21

Plan Statistics for CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN

401k plan membership statisitcs for CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN

Measure Date Value
2015: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 169
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
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 45
Total of all active and inactive participants 2015-01-01 45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 45
Number of participants with account balances 2015-01-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 160
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 151
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 12
Total of all active and inactive participants 2014-01-01 163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 163
Number of participants with account balances 2014-01-01 162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 145
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 13
Total of all active and inactive participants 2013-01-01 158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 158
Number of participants with account balances 2013-01-01 158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 130
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 32
Total of all active and inactive participants 2012-01-01 162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 162
Number of participants with account balances 2012-01-01 162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 108
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 31
Total of all active and inactive participants 2011-01-01 139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 139
Number of participants with account balances 2011-01-01 139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2015: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	169
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
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	45
Total of all active and inactive participants	2015-01-01	45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	45
Number of participants with account balances	2015-01-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	160
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	151
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	12
Total of all active and inactive participants	2014-01-01	163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	163
Number of participants with account balances	2014-01-01	162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	145
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	13
Total of all active and inactive participants	2013-01-01	158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	158
Number of participants with account balances	2013-01-01	158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	130
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	32
Total of all active and inactive participants	2012-01-01	162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	162
Number of participants with account balances	2012-01-01	162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	108
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	31
Total of all active and inactive participants	2011-01-01	139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	139
Number of participants with account balances	2011-01-01	139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN

Measure	Date	Value
2015 : CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets	2015-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2015-12-31	$0
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets to this plan	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	$476,767
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$2,655,307
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$2,640,862
Value of total corrective distributions	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$464,657
Value of total assets at end of year	2015-12-31	$1,324,577
Value of total assets at beginning of year	2015-12-31	$3,503,117
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$14,445
Total income from rents	2015-12-31	$0
Total interest from all sources	2015-12-31	$12,480
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$27,947
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$27,947
Administrative expenses professional fees incurred	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$300,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Amount of non-exempt transactions with any party-in-interest	2015-12-31	$0
Contributions received from participants	2015-12-31	$261,120
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$11,892
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$12,890
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Other income not declared elsewhere	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$0
Liabilities. Value of operating payables at beginning of year	2015-12-31	$0
Total non interest bearing cash at end of year	2015-12-31	$0
Total non interest bearing cash at beginning of year	2015-12-31	$0
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	$-2,178,540
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,324,577
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$3,503,117
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2015-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2015-12-31	$0
Investment advisory and management fees	2015-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$1,029,070
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,769,942
Income. Interest from loans (other than to participants)	2015-12-31	$0
Interest earned on other investments	2015-12-31	$12,480
Income. Interest from US Government securities	2015-12-31	$0
Income. Interest from corporate debt instruments	2015-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$295,507
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$712,010
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-28,317
Net investment gain/loss from pooled separate accounts	2015-12-31	$0
Net investment gain or loss from common/collective trusts	2015-12-31	$0
Net gain/loss from 103.12 investment entities	2015-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$190,647
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$9,273
Income. Dividends from preferred stock	2015-12-31	$0
Income. Dividends from common stock	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$2,640,862
Contract administrator fees	2015-12-31	$14,445
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$0
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
Aggregate proceeds on sale of assets	2015-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2015-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2015-12-31	$0
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	MCSOLEY & MCCOY
Accountancy firm EIN	2015-12-31	030327374
2014 : CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2014 401k financial data
Unrealized appreciation/depreciation of real estate assets	2014-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$0
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total transfer of assets to this plan	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	$823,399
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$371,548
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$357,153
Value of total corrective distributions	2014-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$669,393
Value of total assets at end of year	2014-12-31	$3,503,117
Value of total assets at beginning of year	2014-12-31	$3,051,266
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$14,395
Total income from rents	2014-12-31	$0
Total interest from all sources	2014-12-31	$12,846
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$35,292
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$35,292
Administrative expenses professional fees incurred	2014-12-31	$0
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Amount of non-exempt transactions with any party-in-interest	2014-12-31	$0
Contributions received from participants	2014-12-31	$359,197
Participant contributions at end of year	2014-12-31	$11,892
Participant contributions at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$51,874
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$0
Other income not declared elsewhere	2014-12-31	$3
Administrative expenses (other) incurred	2014-12-31	$0
Liabilities. Value of operating payables at beginning of year	2014-12-31	$0
Total non interest bearing cash at end of year	2014-12-31	$0
Total non interest bearing cash at beginning of year	2014-12-31	$0
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	$451,851
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$3,503,117
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$3,051,266
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2014-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2014-12-31	$0
Investment advisory and management fees	2014-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$2,769,942
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$2,389,210
Income. Interest from loans (other than to participants)	2014-12-31	$0
Interest earned on other investments	2014-12-31	$12,846
Income. Interest from US Government securities	2014-12-31	$0
Income. Interest from corporate debt instruments	2014-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$712,010
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$662,014
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$105,865
Net investment gain/loss from pooled separate accounts	2014-12-31	$0
Net investment gain or loss from common/collective trusts	2014-12-31	$0
Net gain/loss from 103.12 investment entities	2014-12-31	$0
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
Contributions received in cash from employer	2014-12-31	$258,322
Employer contributions (assets) at end of year	2014-12-31	$9,273
Employer contributions (assets) at beginning of year	2014-12-31	$42
Income. Dividends from preferred stock	2014-12-31	$0
Income. Dividends from common stock	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$357,153
Contract administrator fees	2014-12-31	$14,395
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$0
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
Aggregate proceeds on sale of assets	2014-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2014-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2014-12-31	$0
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	MCSOLEY MCCOY & CO.
Accountancy firm EIN	2014-12-31	030327374
2013 : CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2013 401k financial data
Unrealized appreciation/depreciation of real estate assets	2013-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2013-12-31	$0
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total transfer of assets to this plan	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
Expenses. Interest paid	2013-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$911,739
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$585,961
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$573,787
Value of total corrective distributions	2013-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$583,808
Value of total assets at end of year	2013-12-31	$3,051,266
Value of total assets at beginning of year	2013-12-31	$2,725,488
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$12,174
Total income from rents	2013-12-31	$0
Total interest from all sources	2013-12-31	$11,560
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$33,758
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$33,758
Administrative expenses professional fees incurred	2013-12-31	$0
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	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Amount of non-exempt transactions with any party-in-interest	2013-12-31	$0
Contributions received from participants	2013-12-31	$347,885
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$0
Other income not declared elsewhere	2013-12-31	$0
Administrative expenses (other) incurred	2013-12-31	$0
Liabilities. Value of operating payables at beginning of year	2013-12-31	$0
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	2013-12-31	$0
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
Income. Non cash contributions	2013-12-31	$0
Value of net income/loss	2013-12-31	$325,778
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$3,051,266
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,725,488
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2013-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2013-12-31	$0
Investment advisory and management fees	2013-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$2,389,210
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$0
Income. Interest from loans (other than to participants)	2013-12-31	$0
Interest earned on other investments	2013-12-31	$11,560
Income. Interest from US Government securities	2013-12-31	$0
Income. Interest from corporate debt instruments	2013-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$2,724,744
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$2,724,744
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$662,014
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$282,613
Net investment gain/loss from pooled separate accounts	2013-12-31	$0
Net investment gain or loss from common/collective trusts	2013-12-31	$0
Net gain/loss from 103.12 investment entities	2013-12-31	$0
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
Contributions received in cash from employer	2013-12-31	$235,923
Employer contributions (assets) at end of year	2013-12-31	$42
Employer contributions (assets) at beginning of year	2013-12-31	$744
Income. Dividends from preferred stock	2013-12-31	$0
Income. Dividends from common stock	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$573,787
Contract administrator fees	2013-12-31	$12,174
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	Yes
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$0
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
Aggregate proceeds on sale of assets	2013-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2013-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2013-12-31	$0
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	FUST CHARLES CHAMBER LLP
Accountancy firm EIN	2013-12-31	161226221
2012 : CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$844,688
Total of all expenses incurred	2012-12-31	$58,540
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$58,190
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$570,739
Value of total assets at end of year	2012-12-31	$2,725,488
Value of total assets at beginning of year	2012-12-31	$1,939,340
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$350
Total interest from all sources	2012-12-31	$7,897
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$210,000
If this is an individual account plan, was there a blackout period	2012-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$308,726
Participant contributions at beginning of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$-8
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$37,946
Administrative expenses (other) incurred	2012-12-31	$350
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$786,148
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,725,488
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,939,340
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$1,716,083
Interest earned on other investments	2012-12-31	$7,897
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$2,724,744
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$222,378
Net investment gain/loss from pooled separate accounts	2012-12-31	$266,052
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$224,067
Employer contributions (assets) at end of year	2012-12-31	$744
Employer contributions (assets) at beginning of year	2012-12-31	$887
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$58,190
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	Yes
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	FUST CHARLES CHAMBERS LLP
Accountancy firm EIN	2012-12-31	161226221
2011 : CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2011 401k financial data
Total income from all sources (including contributions)	2011-12-31	$671,398
Total of all expenses incurred	2011-12-31	$504,296
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$503,996
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$724,110
Value of total assets at end of year	2011-12-31	$1,939,340
Value of total assets at beginning of year	2011-12-31	$1,772,238
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$300
Total interest from all sources	2011-12-31	$7,524
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$210,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$193,569
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$619
Participant contributions at end of year	2011-12-31	$-8
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$377,098
Administrative expenses (other) incurred	2011-12-31	$300
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$167,102
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,939,340
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,772,238
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$1,716,083
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$1,555,549
Interest on participant loans	2011-12-31	$15
Interest earned on other investments	2011-12-31	$7,509
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$222,378
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$212,325
Net investment gain/loss from pooled separate accounts	2011-12-31	$-60,236
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$153,443
Employer contributions (assets) at end of year	2011-12-31	$887
Employer contributions (assets) at beginning of year	2011-12-31	$3,745
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$503,996
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	FUST CHARLES CHAMBERS LLP
Accountancy firm EIN	2011-12-31	161226221

Form 5500 Responses for CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN

2015: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
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: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
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 – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: CHAMPLAIN VALLEY HEALTH NETWORK, INC. 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	45
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	163
Insurance policy start date	2014-01-01
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	158
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GH2976

Policy instance

Insurance contract or identification number	GH2976
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,326
Total amount of fees paid to insurance company	USD $1,103
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,296
Insurance broker organization code?	3
Amount paid for insurance broker fees	1103
Additional information about fees paid to insurance broker	TPA PARTNERSHIP PROGRAM
Insurance broker name	THE INVESTMENT CENTER INC

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

Policy contract number

GH2976

Policy instance

Insurance contract or identification number	GH2976
Number of Individuals Covered	144
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,825
Total amount of fees paid to insurance company	USD $946
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CHAMPLAIN VALLEY HEALTH NETWORK, INC.
Employer identification number (EIN):	161586102
NAIC Classification:	561110
NAIC Description:	Office Administrative Services

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1996-10-24
Company Identification Number:	2078070
Legal Registered Office Address:	75 BEEKMAN STREET Clinton PLATTSBURGH United States of America (USA) 12901