401k Plan data: SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN plan

SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 401k Plan overview

Plan Name	SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN
Plan identification number	100

SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 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). Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

LUCY-WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES has sponsored the creation of one or more 401k plans.

Company Name: LUCY-WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES

Employer identification number (EIN): 273648520

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
100 2013-01-01
100 2012-01-01 QUEENIE PLATER
100 2011-01-01 QUEENIE PLATER

Plan Statistics for SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN

401k plan membership statisitcs for SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN

Measure Date Value
2013: SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,417
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 527
Number of retired or separated participants receiving benefits 2013-01-01 484
Number of other retired or separated participants entitled to future benefits 2013-01-01 291
Total of all active and inactive participants 2013-01-01 1,302
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 31
Total participants 2013-01-01 1,333
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,419
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 583
Number of retired or separated participants receiving benefits 2012-01-01 449
Number of other retired or separated participants entitled to future benefits 2012-01-01 355
Total of all active and inactive participants 2012-01-01 1,387
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 30
Total participants 2012-01-01 1,417
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,421
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 614
Number of retired or separated participants receiving benefits 2011-01-01 408
Number of other retired or separated participants entitled to future benefits 2011-01-01 369
Total of all active and inactive participants 2011-01-01 1,391
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 28
Total participants 2011-01-01 1,419

Measure	Date	Value
2013: SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,417
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	527
Number of retired or separated participants receiving benefits	2013-01-01	484
Number of other retired or separated participants entitled to future benefits	2013-01-01	291
Total of all active and inactive participants	2013-01-01	1,302
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	31
Total participants	2013-01-01	1,333
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,419
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	583
Number of retired or separated participants receiving benefits	2012-01-01	449
Number of other retired or separated participants entitled to future benefits	2012-01-01	355
Total of all active and inactive participants	2012-01-01	1,387
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	30
Total participants	2012-01-01	1,417
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,421
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	614
Number of retired or separated participants receiving benefits	2011-01-01	408
Number of other retired or separated participants entitled to future benefits	2011-01-01	369
Total of all active and inactive participants	2011-01-01	1,391
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	28
Total participants	2011-01-01	1,419

Financial Data on SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN

Measure	Date	Value
2013 : SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2013-12-31	$-3,088,628
Total unrealized appreciation/depreciation of assets	2013-12-31	$-3,088,628
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$186,347
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$65,772
Total income from all sources (including contributions)	2013-12-31	$12,903,527
Total loss/gain on sale of assets	2013-12-31	$8,907,499
Total of all expenses incurred	2013-12-31	$4,991,988
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$4,562,529
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$5,498,025
Value of total assets at end of year	2013-12-31	$87,594,580
Value of total assets at beginning of year	2013-12-31	$79,562,466
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$429,459
Total interest from all sources	2013-12-31	$1,014,934
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$572,648
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	$575,261
Administrative expenses professional fees incurred	2013-12-31	$378,212
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$10,000,000
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
Other income not declared elsewhere	2013-12-31	$-954
Liabilities. Value of operating payables at end of year	2013-12-31	$186,347
Liabilities. Value of operating payables at beginning of year	2013-12-31	$65,772
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	$7,911,539
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$87,408,233
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$79,496,694
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	$83,799,755
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$75,749,523
Value of interest in pooled separate accounts at end of year	2013-12-31	$757,272
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$705,218
Interest earned on other investments	2013-12-31	$880,100
Income. Interest from US Government securities	2013-12-31	$134,834
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$3,037,553
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$3,107,725
Net investment gain/loss from pooled separate accounts	2013-12-31	$3
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	$5,498,025
Income. Dividends from common stock	2013-12-31	$-2,613
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$4,562,529
Contract administrator fees	2013-12-31	$51,247
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	$256,060,599
Aggregate carrying amount (costs) on sale of assets	2013-12-31	$247,153,100
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	SB & COMPANY, LLC
Accountancy firm EIN	2013-12-31	202173727
2012 : SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$933,598
Total unrealized appreciation/depreciation of assets	2012-12-31	$933,598
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$65,772
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$510,324
Total income from all sources (including contributions)	2012-12-31	$12,337,117
Total loss/gain on sale of assets	2012-12-31	$5,101,184
Total of all expenses incurred	2012-12-31	$4,576,484
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$4,206,840
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$4,000,000
Value of total assets at end of year	2012-12-31	$79,562,466
Value of total assets at beginning of year	2012-12-31	$72,246,385
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$369,644
Total interest from all sources	2012-12-31	$1,737,946
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$564,399
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$69
Administrative expenses professional fees incurred	2012-12-31	$9,718
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Administrative expenses (other) incurred	2012-12-31	$30,026
Liabilities. Value of operating payables at end of year	2012-12-31	$65,772
Liabilities. Value of operating payables at beginning of year	2012-12-31	$510,324
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	$7,760,633
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$79,496,694
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$71,736,061
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
Investment advisory and management fees	2012-12-31	$279,618
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$75,749,523
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$65,340,388
Value of interest in pooled separate accounts at end of year	2012-12-31	$705,218
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$657,934
Interest earned on other investments	2012-12-31	$693,157
Income. Interest from US Government securities	2012-12-31	$184,323
Income. Interest from corporate debt instruments	2012-12-31	$860,466
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$3,107,725
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$2,948,063
Net investment gain/loss from pooled separate accounts	2012-12-31	$-10
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
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	$4,000,000
Employer contributions (assets) at beginning of year	2012-12-31	$3,300,000
Income. Dividends from common stock	2012-12-31	$564,330
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$4,206,840
Contract administrator fees	2012-12-31	$50,282
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
Aggregate proceeds on sale of assets	2012-12-31	$149,329,805
Aggregate carrying amount (costs) on sale of assets	2012-12-31	$144,228,621
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	SB & COMPANY, LLC
Accountancy firm EIN	2012-12-31	202173727
2011 : SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$3,759,053
Total unrealized appreciation/depreciation of assets	2011-12-31	$3,759,053
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$510,324
Total income from all sources (including contributions)	2011-12-31	$8,832,096
Total loss/gain on sale of assets	2011-12-31	$-1,463,191
Total of all expenses incurred	2011-12-31	$3,431,094
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$3,140,262
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$4,800,000
Value of total assets at end of year	2011-12-31	$72,246,385
Value of total assets at beginning of year	2011-12-31	$66,335,059
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$290,832
Total interest from all sources	2011-12-31	$1,142,221
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$550,836
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$242,249
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Liabilities. Value of operating payables at end of year	2011-12-31	$510,324
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	$5,401,002
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$71,736,061
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$66,335,059
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 registered invesment companies (eg mutual funds) at end of year	2011-12-31	$65,340,388
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$62,778,923
Value of interest in pooled separate accounts at end of year	2011-12-31	$657,934
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$600,523
Interest earned on other investments	2011-12-31	$150,408
Income. Interest from US Government securities	2011-12-31	$324,546
Income. Interest from corporate debt instruments	2011-12-31	$667,267
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$2,948,063
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$2,955,613
Net investment gain/loss from pooled separate accounts	2011-12-31	$43,034
Net investment gain or loss from common/collective trusts	2011-12-31	$143
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	$4,800,000
Employer contributions (assets) at end of year	2011-12-31	$3,300,000
Income. Dividends from common stock	2011-12-31	$550,836
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$3,140,262
Contract administrator fees	2011-12-31	$48,583
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
Aggregate proceeds on sale of assets	2011-12-31	$40,851,955
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$42,315,146
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	SB & COMPANY, LLC
Accountancy firm EIN	2011-12-31	202173727

Form 5500 Responses for SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN

2013: SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
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: SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
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: SIBLEY MEMORIAL HOSPITAL RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
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

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Company Name:	LUCY-WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES
Employer identification number (EIN):	273648520
NAIC Classification:	622000
NAIC Description:	Hospitals

Plan id#	Filing Submission Date	Name of Administrator
100	2013-01-01
100	2012-01-01	QUEENIE PLATER
100	2011-01-01	QUEENIE PLATER