401k Plan data: PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL plan

PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 401k Plan overview

Plan Name	PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL
Plan identification number	001

PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL Benefits

401k Plan Type	Defined Benefit Pension
Plan Features/Benefits	Benefits are primarily pay related Covered by PBGC - Plan is covered under the PBGC insurance program (see ERISA section 4021). Frozen Plan - As of the last day of the plan year, the plan provides that no participant will get any new benefit accrual (whether because of service or compensation).

401k Sponsoring company profile

BAYSTATE NOBLE HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: BAYSTATE NOBLE HOSPITAL

Employer identification number (EIN): 222537423

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-03-01 MICHAEL FALLON
001 2011-03-01 MICHAEL FALLON
001 2010-03-01 MICHAEL FALLON
001 2009-03-01 MICHAEL FALLON

Plan id#	Filing Submission Date	Name of Administrator
001	2012-03-01	MICHAEL FALLON
001	2011-03-01	MICHAEL FALLON
001	2010-03-01	MICHAEL FALLON
001	2009-03-01	MICHAEL FALLON

Plan Statistics for PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL

401k plan membership statisitcs for PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL

Measure Date Value
2012: PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2012 401k membership
Total participants, beginning-of-year 2012-03-01 819
Total number of active participants reported on line 7a of the Form 5500 2012-03-01 200
Number of retired or separated participants receiving benefits 2012-03-01 256
Number of other retired or separated participants entitled to future benefits 2012-03-01 331
Total of all active and inactive participants 2012-03-01 787
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-03-01 20
Total participants 2012-03-01 807
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-03-01 0
2011: PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2011 401k membership
Total participants, beginning-of-year 2011-03-01 833
Total number of active participants reported on line 7a of the Form 5500 2011-03-01 249
Number of retired or separated participants receiving benefits 2011-03-01 243
Number of other retired or separated participants entitled to future benefits 2011-03-01 307
Total of all active and inactive participants 2011-03-01 799
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-03-01 20
Total participants 2011-03-01 819
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-03-01 1
2010: PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2010 401k membership
Total participants, beginning-of-year 2010-03-01 900
Total number of active participants reported on line 7a of the Form 5500 2010-03-01 267
Number of retired or separated participants receiving benefits 2010-03-01 229
Number of other retired or separated participants entitled to future benefits 2010-03-01 317
Total of all active and inactive participants 2010-03-01 813
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-03-01 20
Total participants 2010-03-01 833
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-03-01 8
2009: PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2009 401k membership
Total participants, beginning-of-year 2009-03-01 917
Total number of active participants reported on line 7a of the Form 5500 2009-03-01 313
Number of retired or separated participants receiving benefits 2009-03-01 212
Number of other retired or separated participants entitled to future benefits 2009-03-01 360
Total of all active and inactive participants 2009-03-01 885
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-03-01 15
Total participants 2009-03-01 900
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-03-01 15

Measure	Date	Value
2012: PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2012 401k membership
Total participants, beginning-of-year	2012-03-01	819
Total number of active participants reported on line 7a of the Form 5500	2012-03-01	200
Number of retired or separated participants receiving benefits	2012-03-01	256
Number of other retired or separated participants entitled to future benefits	2012-03-01	331
Total of all active and inactive participants	2012-03-01	787
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-03-01	20
Total participants	2012-03-01	807
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-03-01	0
2011: PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2011 401k membership
Total participants, beginning-of-year	2011-03-01	833
Total number of active participants reported on line 7a of the Form 5500	2011-03-01	249
Number of retired or separated participants receiving benefits	2011-03-01	243
Number of other retired or separated participants entitled to future benefits	2011-03-01	307
Total of all active and inactive participants	2011-03-01	799
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-03-01	20
Total participants	2011-03-01	819
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-03-01	1
2010: PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2010 401k membership
Total participants, beginning-of-year	2010-03-01	900
Total number of active participants reported on line 7a of the Form 5500	2010-03-01	267
Number of retired or separated participants receiving benefits	2010-03-01	229
Number of other retired or separated participants entitled to future benefits	2010-03-01	317
Total of all active and inactive participants	2010-03-01	813
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-03-01	20
Total participants	2010-03-01	833
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-03-01	8
2009: PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2009 401k membership
Total participants, beginning-of-year	2009-03-01	917
Total number of active participants reported on line 7a of the Form 5500	2009-03-01	313
Number of retired or separated participants receiving benefits	2009-03-01	212
Number of other retired or separated participants entitled to future benefits	2009-03-01	360
Total of all active and inactive participants	2009-03-01	885
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-03-01	15
Total participants	2009-03-01	900
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-03-01	15

Financial Data on PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL

Measure	Date	Value
2013 : PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-02-28	$0
Total transfer of assets to this plan	2013-02-28	$0
Total transfer of assets from this plan	2013-02-28	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-02-28	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-02-28	$0
Total income from all sources (including contributions)	2013-02-28	$2,350,244
Total loss/gain on sale of assets	2013-02-28	$0
Total of all expenses incurred	2013-02-28	$2,089,167
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-02-28	$1,684,126
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-02-28	$0
Value of total assets at end of year	2013-02-28	$27,603,833
Value of total assets at beginning of year	2013-02-28	$27,342,756
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-02-28	$405,041
Total interest from all sources	2013-02-28	$127,084
Total dividends received (eg from common stock, registered investment company shares)	2013-02-28	$2,223,160
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-02-28	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-02-28	$2,223,160
Administrative expenses professional fees incurred	2013-02-28	$145,363
Was this plan covered by a fidelity bond	2013-02-28	Yes
Value of fidelity bond cover	2013-02-28	$2,000,000
If this is an individual account plan, was there a blackout period	2013-02-28	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-02-28	$0
Were there any nonexempt tranactions with any party-in-interest	2013-02-28	No
Administrative expenses (other) incurred	2013-02-28	$118,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-02-28	No
Value of net income/loss	2013-02-28	$261,077
Value of net assets at end of year (total assets less liabilities)	2013-02-28	$27,603,833
Value of net assets at beginning of year (total assets less liabilities)	2013-02-28	$27,342,756
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-02-28	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-02-28	No
Were any leases to which the plan was party in default or uncollectible	2013-02-28	No
Investment advisory and management fees	2013-02-28	$123,229
Value of interest in pooled separate accounts at end of year	2013-02-28	$23,126,579
Value of interest in pooled separate accounts at beginning of year	2013-02-28	$22,781,963
Interest earned on other investments	2013-02-28	$127,084
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-02-28	$4,477,254
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-02-28	$4,560,793
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-02-28	$1,680,973
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-02-28	No
Was there a failure to transmit to the plan any participant contributions	2013-02-28	No
Has the plan failed to provide any benefit when due under the plan	2013-02-28	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-02-28	$1,684,126
Contract administrator fees	2013-02-28	$18,449
Did the plan have assets held for investment	2013-02-28	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	2013-02-28	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-02-28	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-02-28	Yes
Opinion of an independent qualified public accountant for this plan	2013-02-28	Disclaimer
Accountancy firm name	2013-02-28	MORIARTY & PRIMACK, CPA
Accountancy firm EIN	2013-02-28	043191789
2012 : PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-02-29	$618,259
Total unrealized appreciation/depreciation of assets	2012-02-29	$618,259
Total transfer of assets to this plan	2012-02-29	$0
Total transfer of assets from this plan	2012-02-29	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-02-29	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-02-29	$0
Total income from all sources (including contributions)	2012-02-29	$1,306,601
Total loss/gain on sale of assets	2012-02-29	$0
Total of all expenses incurred	2012-02-29	$1,859,382
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-02-29	$1,484,398
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-02-29	$0
Value of total assets at end of year	2012-02-29	$27,342,756
Value of total assets at beginning of year	2012-02-29	$27,895,537
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-02-29	$374,984
Total interest from all sources	2012-02-29	$169,209
Total dividends received (eg from common stock, registered investment company shares)	2012-02-29	$519,133
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-02-29	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-02-29	$519,133
Administrative expenses professional fees incurred	2012-02-29	$126,086
Was this plan covered by a fidelity bond	2012-02-29	Yes
Value of fidelity bond cover	2012-02-29	$2,000,000
If this is an individual account plan, was there a blackout period	2012-02-29	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-02-29	$0
Were there any nonexempt tranactions with any party-in-interest	2012-02-29	No
Other income not declared elsewhere	2012-02-29	$0
Administrative expenses (other) incurred	2012-02-29	$77,275
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-02-29	No
Value of net income/loss	2012-02-29	$-552,781
Value of net assets at end of year (total assets less liabilities)	2012-02-29	$27,342,756
Value of net assets at beginning of year (total assets less liabilities)	2012-02-29	$27,895,537
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-02-29	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-02-29	No
Were any leases to which the plan was party in default or uncollectible	2012-02-29	No
Investment advisory and management fees	2012-02-29	$153,082
Value of interest in pooled separate accounts at end of year	2012-02-29	$22,781,963
Value of interest in pooled separate accounts at beginning of year	2012-02-29	$22,905,828
Interest earned on other investments	2012-02-29	$169,209
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-02-29	$4,560,793
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-02-29	$4,989,709
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-02-29	No
Was there a failure to transmit to the plan any participant contributions	2012-02-29	No
Has the plan failed to provide any benefit when due under the plan	2012-02-29	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-02-29	$1,484,398
Contract administrator fees	2012-02-29	$18,541
Did the plan have assets held for investment	2012-02-29	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	2012-02-29	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-02-29	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-02-29	Yes
Opinion of an independent qualified public accountant for this plan	2012-02-29	Disclaimer
Accountancy firm name	2012-02-29	MORIARTY & PRIMACK, CPA
Accountancy firm EIN	2012-02-29	043191789
2011 : PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-02-28	$3,866,133
Total unrealized appreciation/depreciation of assets	2011-02-28	$3,866,133
Total transfer of assets to this plan	2011-02-28	$0
Total transfer of assets from this plan	2011-02-28	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-02-28	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-02-28	$0
Total income from all sources (including contributions)	2011-02-28	$5,046,347
Total loss/gain on sale of assets	2011-02-28	$407,829
Total of all expenses incurred	2011-02-28	$1,809,700
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-02-28	$1,504,162
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-02-28	$0
Value of total assets at end of year	2011-02-28	$27,895,537
Value of total assets at beginning of year	2011-02-28	$24,658,890
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-02-28	$305,538
Total interest from all sources	2011-02-28	$207,165
Total dividends received (eg from common stock, registered investment company shares)	2011-02-28	$480,865
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-02-28	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-02-28	$480,865
Administrative expenses professional fees incurred	2011-02-28	$106,103
Was this plan covered by a fidelity bond	2011-02-28	Yes
Value of fidelity bond cover	2011-02-28	$2,000,000
If this is an individual account plan, was there a blackout period	2011-02-28	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-02-28	$0
Were there any nonexempt tranactions with any party-in-interest	2011-02-28	No
Other income not declared elsewhere	2011-02-28	$84,355
Administrative expenses (other) incurred	2011-02-28	$86,819
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-02-28	No
Value of net income/loss	2011-02-28	$3,236,647
Value of net assets at end of year (total assets less liabilities)	2011-02-28	$27,895,537
Value of net assets at beginning of year (total assets less liabilities)	2011-02-28	$24,658,890
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-02-28	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-02-28	No
Were any leases to which the plan was party in default or uncollectible	2011-02-28	No
Investment advisory and management fees	2011-02-28	$92,017
Value of interest in pooled separate accounts at end of year	2011-02-28	$22,905,828
Value of interest in pooled separate accounts at beginning of year	2011-02-28	$20,306,838
Interest earned on other investments	2011-02-28	$207,165
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-02-28	$4,989,709
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-02-28	$4,352,052
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-02-28	No
Was there a failure to transmit to the plan any participant contributions	2011-02-28	No
Has the plan failed to provide any benefit when due under the plan	2011-02-28	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-02-28	$1,504,162
Contract administrator fees	2011-02-28	$20,599
Did the plan have assets held for investment	2011-02-28	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	2011-02-28	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-02-28	No
Aggregate proceeds on sale of assets	2011-02-28	$6,022,167
Aggregate carrying amount (costs) on sale of assets	2011-02-28	$5,614,338
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-02-28	Yes
Opinion of an independent qualified public accountant for this plan	2011-02-28	Disclaimer
Accountancy firm name	2011-02-28	MORIARTY & PRIMACK, CPA
Accountancy firm EIN	2011-02-28	043191789
2010 : PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-02-28	$0

Form 5500 Responses for PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL

2012: PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2012 form 5500 responses
2012-03-01	Type of plan entity	Single employer plan
2012-03-01	Submission has been amended	Yes
2012-03-01	This submission is the final filing	No
2012-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-03-01	Plan is a collectively bargained plan	No
2012-03-01	Plan funding arrangement – Insurance	Yes
2012-03-01	Plan funding arrangement – Trust	Yes
2012-03-01	Plan benefit arrangement – Insurance	Yes
2012-03-01	Plan benefit arrangement - Trust	Yes
2011: PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2011 form 5500 responses
2011-03-01	Type of plan entity	Single employer plan
2011-03-01	Submission has been amended	No
2011-03-01	This submission is the final filing	No
2011-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-03-01	Plan is a collectively bargained plan	No
2011-03-01	Plan funding arrangement – Insurance	Yes
2011-03-01	Plan funding arrangement – Trust	Yes
2011-03-01	Plan benefit arrangement – Insurance	Yes
2011-03-01	Plan benefit arrangement - Trust	Yes
2010: PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2010 form 5500 responses
2010-03-01	Type of plan entity	Single employer plan
2010-03-01	Submission has been amended	No
2010-03-01	This submission is the final filing	No
2010-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-03-01	Plan is a collectively bargained plan	No
2010-03-01	Plan funding arrangement – Insurance	Yes
2010-03-01	Plan funding arrangement – Trust	Yes
2010-03-01	Plan benefit arrangement – Insurance	Yes
2010-03-01	Plan benefit arrangement - Trust	Yes
2009: PENSION PLAN FOR EMPLOYEES OF NOBLE HOSPITAL 2009 form 5500 responses
2009-03-01	Type of plan entity	Single employer plan
2009-03-01	Submission has been amended	No
2009-03-01	This submission is the final filing	No
2009-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-03-01	Plan is a collectively bargained plan	No
2009-03-01	Plan funding arrangement – Insurance	Yes
2009-03-01	Plan funding arrangement – Trust	Yes
2009-03-01	Plan benefit arrangement – Insurance	Yes
2009-03-01	Plan benefit arrangement - Trust	Yes

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Company Name:	BAYSTATE NOBLE HOSPITAL
Employer identification number (EIN):	222537423
NAIC Classification:	622000
NAIC Description:	Hospitals