401k Plan data: COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN plan

COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN 401k Plan overview

Plan Name	COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN
Plan identification number	003

COMMUNITY HOSPITALS OF INDIANA REPLACEMENT 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). Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

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

Company Name: COMMUNITY HEALTH NETWORK, INC.

Employer identification number (EIN): 311038302

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2011-01-01 PATRICIA EDWARDS
003 2010-01-01 PATRICIA EDWARDS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2011-01-01	PATRICIA EDWARDS
003	2010-01-01	PATRICIA EDWARDS

Plan Statistics for COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN

401k plan membership statisitcs for COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN

Measure Date Value
2011: COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,826
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 450
Number of retired or separated participants receiving benefits 2011-01-01 584
Number of other retired or separated participants entitled to future benefits 2011-01-01 681
Total of all active and inactive participants 2011-01-01 1,715
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 84
Total participants 2011-01-01 1,799
2010: COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1,839
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 462
Number of retired or separated participants receiving benefits 2010-01-01 588
Number of other retired or separated participants entitled to future benefits 2010-01-01 694
Total of all active and inactive participants 2010-01-01 1,744
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 82
Total participants 2010-01-01 1,826
Number of participants with account balances 2010-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0

Measure	Date	Value
2011: COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,826
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	450
Number of retired or separated participants receiving benefits	2011-01-01	584
Number of other retired or separated participants entitled to future benefits	2011-01-01	681
Total of all active and inactive participants	2011-01-01	1,715
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	84
Total participants	2011-01-01	1,799
2010: COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,839
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	462
Number of retired or separated participants receiving benefits	2010-01-01	588
Number of other retired or separated participants entitled to future benefits	2010-01-01	694
Total of all active and inactive participants	2010-01-01	1,744
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	82
Total participants	2010-01-01	1,826
Number of participants with account balances	2010-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0

Financial Data on COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN

Measure	Date	Value
2011 : COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$29,280
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$66,017
Total income from all sources (including contributions)	2011-12-31	$1,642,135
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$724,021
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$577,194
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$2,100,000
Value of total assets at end of year	2011-12-31	$12,277,382
Value of total assets at beginning of year	2011-12-31	$11,396,005
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$146,827
Total interest from all sources	2011-12-31	$13
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
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	$50,000
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
Administrative expenses (other) incurred	2011-12-31	$82,602
Liabilities. Value of operating payables at end of year	2011-12-31	$29,280
Liabilities. Value of operating payables at beginning of year	2011-12-31	$66,017
Total non interest bearing cash at end of year	2011-12-31	$76,756
Total non interest bearing cash at beginning of year	2011-12-31	$12,237
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	$918,114
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$12,248,102
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$11,329,988
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
Assets. partnership/joint venture interests at end of year	2011-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2011-12-31	$539,960
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$9,051,558
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$10,807,856
Value of interest in common/collective trusts at end of year	2011-12-31	$1,049,068
Value of interest in common/collective trusts at beginning of year	2011-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$35,952
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$35,952
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$13
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-456,946
Net investment gain or loss from common/collective trusts	2011-12-31	$-932
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
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	$2,100,000
Employer contributions (assets) at end of year	2011-12-31	$2,100,000
Employer contributions (assets) at beginning of year	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$577,194
Contract administrator fees	2011-12-31	$64,225
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	PRICEWATERHOUSECOOPERS, LLP
Accountancy firm EIN	2011-12-31	134008324
2010 : COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$66,017
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$64,387
Total income from all sources (including contributions)	2010-12-31	$1,498,323
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$720,998
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$577,433
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$0
Value of total assets at end of year	2010-12-31	$11,396,005
Value of total assets at beginning of year	2010-12-31	$10,617,050
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$143,565
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Other income not declared elsewhere	2010-12-31	$40,211
Administrative expenses (other) incurred	2010-12-31	$65,355
Liabilities. Value of operating payables at end of year	2010-12-31	$66,017
Liabilities. Value of operating payables at beginning of year	2010-12-31	$64,387
Total non interest bearing cash at end of year	2010-12-31	$12,237
Total non interest bearing cash at beginning of year	2010-12-31	$17,322
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$777,325
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$11,329,988
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$10,552,663
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Assets. partnership/joint venture interests at end of year	2010-12-31	$539,960
Assets. partnership/joint venture interests at beginning of year	2010-12-31	$1,042,496
Investment advisory and management fees	2010-12-31	$13,705
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$10,807,856
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$9,551,287
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$35,952
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$5,945
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$5,945
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$1,458,112
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$577,433
Contract administrator fees	2010-12-31	$64,505
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Aggregate proceeds on sale of assets	2010-12-31	$270,175
Aggregate carrying amount (costs) on sale of assets	2010-12-31	$270,175
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	PRICEWATERHOUSECOOPERS, LLP
Accountancy firm EIN	2010-12-31	134008324

Form 5500 Responses for COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN

2011: COMMUNITY HOSPITALS OF INDIANA REPLACEMENT 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: COMMUNITY HOSPITALS OF INDIANA REPLACEMENT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	COMMUNITY HEALTH NETWORK, INC.
Employer identification number (EIN):	311038302
NAIC Classification:	622000
NAIC Description:	Hospitals