401k Plan data: THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN plan

THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 401k Plan overview

Plan Name	THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN
Plan identification number	001

THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
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

THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME has sponsored the creation of one or more 401k plans.

Company Name: THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME

Employer identification number (EIN): 363637465

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-10-01 HARRY BROCKUS
001 2011-10-01 HARRY BROCKUS
001 2009-10-01 BETSY MORGENROTH
001 2009-10-01 BETSY MORGENROTH
001 2008-10-01

Plan Statistics for THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN

401k plan membership statisitcs for THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN

Measure Date Value
2012: THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 172
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 0
Number of retired or separated participants receiving benefits 2012-10-01 0
Number of other retired or separated participants entitled to future benefits 2012-10-01 0
Total of all active and inactive participants 2012-10-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-10-01 0
Total participants 2012-10-01 0
Number of participants with account balances 2012-10-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-10-01 0
2011: THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 215
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 194
Number of retired or separated participants receiving benefits 2011-10-01 2
Number of other retired or separated participants entitled to future benefits 2011-10-01 9
Total of all active and inactive participants 2011-10-01 205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-10-01 0
Total participants 2011-10-01 205
Number of participants with account balances 2011-10-01 88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-10-01 0
2009: THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 26
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 0
Number of retired or separated participants receiving benefits 2009-10-01 0
Number of other retired or separated participants entitled to future benefits 2009-10-01 0
Total of all active and inactive participants 2009-10-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-10-01 0
Total participants 2009-10-01 0
Number of participants with account balances 2009-10-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-10-01 0

Measure	Date	Value
2012: THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	172
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	0
Number of retired or separated participants receiving benefits	2012-10-01	0
Number of other retired or separated participants entitled to future benefits	2012-10-01	0
Total of all active and inactive participants	2012-10-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-10-01	0
Total participants	2012-10-01	0
Number of participants with account balances	2012-10-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-10-01	0
2011: THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	215
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	194
Number of retired or separated participants receiving benefits	2011-10-01	2
Number of other retired or separated participants entitled to future benefits	2011-10-01	9
Total of all active and inactive participants	2011-10-01	205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-10-01	0
Total participants	2011-10-01	205
Number of participants with account balances	2011-10-01	88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-10-01	0
2009: THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	26
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	0
Number of retired or separated participants receiving benefits	2009-10-01	0
Number of other retired or separated participants entitled to future benefits	2009-10-01	0
Total of all active and inactive participants	2009-10-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-10-01	0
Total participants	2009-10-01	0
Number of participants with account balances	2009-10-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-10-01	0

Financial Data on THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN

Measure	Date	Value
2013 : THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-01-15	$0
Total transfer of assets from this plan	2013-01-15	$1,503,903
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-01-15	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-01-15	$0
Total income from all sources (including contributions)	2013-01-15	$119,386
Total loss/gain on sale of assets	2013-01-15	$37,758
Total of all expenses incurred	2013-01-15	$83,538
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-01-15	$76,211
Expenses. Certain deemed distributions of participant loans	2013-01-15	$382
Value of total corrective distributions	2013-01-15	$4,755
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-01-15	$71,735
Value of total assets at end of year	2013-01-15	$0
Value of total assets at beginning of year	2013-01-15	$1,468,055
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-01-15	$2,190
Total interest from all sources	2013-01-15	$187
Total dividends received (eg from common stock, registered investment company shares)	2013-01-15	$9,706
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-01-15	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2013-01-15	$0
Total dividends received from registered investment company shares (eg mutual funds)	2013-01-15	$9,706
Assets. Real estate other than employer real property at end of year	2013-01-15	$0
Assets. Real estate other than employer real property at beginning of year	2013-01-15	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2013-01-15	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2013-01-15	$0
Was this plan covered by a fidelity bond	2013-01-15	Yes
Value of fidelity bond cover	2013-01-15	$200,000
If this is an individual account plan, was there a blackout period	2013-01-15	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-01-15	$0
Were there any nonexempt tranactions with any party-in-interest	2013-01-15	No
Contributions received from participants	2013-01-15	$50,716
Participant contributions at end of year	2013-01-15	$0
Participant contributions at beginning of year	2013-01-15	$15,710
Participant contributions at end of year	2013-01-15	$0
Participant contributions at beginning of year	2013-01-15	$9,308
Assets. Other investments not covered elsewhere at end of year	2013-01-15	$0
Assets. Other investments not covered elsewhere at beginning of year	2013-01-15	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-01-15	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-01-15	$32
Assets. Loans (other than to participants) at end of year	2013-01-15	$0
Assets. Loans (other than to participants) at beginning of year	2013-01-15	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-01-15	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-01-15	$0
Liabilities. Value of operating payables at end of year	2013-01-15	$0
Liabilities. Value of operating payables at beginning of year	2013-01-15	$0
Total non interest bearing cash at end of year	2013-01-15	$0
Total non interest bearing cash at beginning of year	2013-01-15	$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	2013-01-15	No
Value of net income/loss	2013-01-15	$35,848
Value of net assets at end of year (total assets less liabilities)	2013-01-15	$0
Value of net assets at beginning of year (total assets less liabilities)	2013-01-15	$1,468,055
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-01-15	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-01-15	No
Were any leases to which the plan was party in default or uncollectible	2013-01-15	No
Assets. partnership/joint venture interests at end of year	2013-01-15	$0
Assets. partnership/joint venture interests at beginning of year	2013-01-15	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-01-15	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-01-15	$1,442,212
Interest on participant loans	2013-01-15	$187
Value of interest in master investment trust accounts at end of year	2013-01-15	$0
Value of interest in master investment trust accounts at beginning of year	2013-01-15	$0
Value of interest in common/collective trusts at end of year	2013-01-15	$0
Value of interest in common/collective trusts at beginning of year	2013-01-15	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-01-15	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-01-15	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-01-15	$0
Assets. Value of investments in 103.12 investment entities at end of year	2013-01-15	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2013-01-15	$0
Asset value of US Government securities at end of year	2013-01-15	$0
Asset value of US Government securities at beginning of year	2013-01-15	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-01-15	No
Was there a failure to transmit to the plan any participant contributions	2013-01-15	No
Has the plan failed to provide any benefit when due under the plan	2013-01-15	No
Assets. Invements in employer securities at end of year	2013-01-15	$0
Assets. Invements in employer securities at beginning of year	2013-01-15	$0
Assets. Value of employer real property at end of year	2013-01-15	$0
Assets. Value of employer real property at beginning of year	2013-01-15	$0
Contributions received in cash from employer	2013-01-15	$21,019
Employer contributions (assets) at end of year	2013-01-15	$0
Employer contributions (assets) at beginning of year	2013-01-15	$793
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-01-15	$76,211
Asset. Corporate debt instrument preferred debt at end of year	2013-01-15	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2013-01-15	$0
Asset. Corporate debt instrument debt (other) at end of year	2013-01-15	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2013-01-15	$0
Contract administrator fees	2013-01-15	$2,190
Assets. Corporate common stocks other than exployer securities at end of year	2013-01-15	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2013-01-15	$0
Liabilities. Value of benefit claims payable at end of year	2013-01-15	$0
Liabilities. Value of benefit claims payable at beginning of year	2013-01-15	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2013-01-15	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2013-01-15	$0
Did the plan have assets held for investment	2013-01-15	No
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	2013-01-15	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-01-15	Yes
Aggregate proceeds on sale of assets	2013-01-15	$1,597,142
Aggregate carrying amount (costs) on sale of assets	2013-01-15	$1,559,384
Liabilities. Value of acquisition indebtedness at end of year	2013-01-15	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2013-01-15	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-01-15	No
Opinion of an independent qualified public accountant for this plan	2013-01-15	Unqualified
Accountancy firm name	2013-01-15	WEST & COMPANY, LLC
Accountancy firm EIN	2013-01-15	370980065
2012 : THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$0
Total income from all sources (including contributions)	2012-09-30	$511,295
Total loss/gain on sale of assets	2012-09-30	$29,369
Total of all expenses incurred	2012-09-30	$270,424
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-09-30	$264,096
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-09-30	$306,038
Value of total assets at end of year	2012-09-30	$1,468,055
Value of total assets at beginning of year	2012-09-30	$1,227,184
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-09-30	$6,328
Total interest from all sources	2012-09-30	$671
Total dividends received (eg from common stock, registered investment company shares)	2012-09-30	$16,778
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-09-30	$16,778
Assets. Real estate other than employer real property at end of year	2012-09-30	$0
Assets. Real estate other than employer real property at beginning of year	2012-09-30	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2012-09-30	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2012-09-30	$0
Was this plan covered by a fidelity bond	2012-09-30	Yes
Value of fidelity bond cover	2012-09-30	$200,000
If this is an individual account plan, was there a blackout period	2012-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2012-09-30	No
Contributions received from participants	2012-09-30	$248,029
Participant contributions at end of year	2012-09-30	$15,710
Participant contributions at beginning of year	2012-09-30	$11,347
Participant contributions at end of year	2012-09-30	$9,308
Participant contributions at beginning of year	2012-09-30	$8,586
Assets. Other investments not covered elsewhere at end of year	2012-09-30	$0
Assets. Other investments not covered elsewhere at beginning of year	2012-09-30	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-09-30	$32
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-09-30	$23
Assets. Loans (other than to participants) at end of year	2012-09-30	$0
Assets. Loans (other than to participants) at beginning of year	2012-09-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-09-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-09-30	$0
Liabilities. Value of operating payables at end of year	2012-09-30	$0
Liabilities. Value of operating payables at beginning of year	2012-09-30	$0
Total non interest bearing cash at end of year	2012-09-30	$0
Total non interest bearing cash at beginning of year	2012-09-30	$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	2012-09-30	No
Value of net income/loss	2012-09-30	$240,871
Value of net assets at end of year (total assets less liabilities)	2012-09-30	$1,468,055
Value of net assets at beginning of year (total assets less liabilities)	2012-09-30	$1,227,184
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-09-30	No
Were any leases to which the plan was party in default or uncollectible	2012-09-30	No
Assets. partnership/joint venture interests at end of year	2012-09-30	$0
Assets. partnership/joint venture interests at beginning of year	2012-09-30	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-09-30	$1,442,212
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-09-30	$1,206,173
Interest on participant loans	2012-09-30	$671
Value of interest in master investment trust accounts at end of year	2012-09-30	$0
Value of interest in master investment trust accounts at beginning of year	2012-09-30	$0
Value of interest in common/collective trusts at end of year	2012-09-30	$0
Value of interest in common/collective trusts at beginning of year	2012-09-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-09-30	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-09-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-09-30	$0
Assets. Value of investments in 103.12 investment entities at end of year	2012-09-30	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2012-09-30	$0
Asset value of US Government securities at end of year	2012-09-30	$0
Asset value of US Government securities at beginning of year	2012-09-30	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-09-30	$158,439
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-09-30	No
Was there a failure to transmit to the plan any participant contributions	2012-09-30	No
Has the plan failed to provide any benefit when due under the plan	2012-09-30	No
Assets. Invements in employer securities at end of year	2012-09-30	$0
Assets. Invements in employer securities at beginning of year	2012-09-30	$0
Assets. Value of employer real property at end of year	2012-09-30	$0
Assets. Value of employer real property at beginning of year	2012-09-30	$0
Contributions received in cash from employer	2012-09-30	$58,009
Employer contributions (assets) at end of year	2012-09-30	$793
Employer contributions (assets) at beginning of year	2012-09-30	$1,055
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-09-30	$264,096
Asset. Corporate debt instrument preferred debt at end of year	2012-09-30	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2012-09-30	$0
Asset. Corporate debt instrument debt (other) at end of year	2012-09-30	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2012-09-30	$0
Contract administrator fees	2012-09-30	$6,328
Assets. Corporate common stocks other than exployer securities at end of year	2012-09-30	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2012-09-30	$0
Liabilities. Value of benefit claims payable at end of year	2012-09-30	$0
Liabilities. Value of benefit claims payable at beginning of year	2012-09-30	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2012-09-30	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2012-09-30	$0
Did the plan have assets held for investment	2012-09-30	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	2012-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-09-30	No
Aggregate proceeds on sale of assets	2012-09-30	$350,797
Aggregate carrying amount (costs) on sale of assets	2012-09-30	$321,428
Liabilities. Value of acquisition indebtedness at end of year	2012-09-30	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2012-09-30	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-09-30	No
Opinion of an independent qualified public accountant for this plan	2012-09-30	Unqualified
Accountancy firm name	2012-09-30	WEST & COMPANY, LLC
Accountancy firm EIN	2012-09-30	370980065
2011 : THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$0
Total income from all sources (including contributions)	2011-09-30	$267,002
Total loss/gain on sale of assets	2011-09-30	$5,583
Total of all expenses incurred	2011-09-30	$96,179
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-09-30	$90,010
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-09-30	$289,776
Value of total assets at end of year	2011-09-30	$1,227,184
Value of total assets at beginning of year	2011-09-30	$1,056,361
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-09-30	$6,169
Total interest from all sources	2011-09-30	$411
Total dividends received (eg from common stock, registered investment company shares)	2011-09-30	$16,154
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-09-30	$16,154
Assets. Real estate other than employer real property at end of year	2011-09-30	$0
Assets. Real estate other than employer real property at beginning of year	2011-09-30	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2011-09-30	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2011-09-30	$0
Was this plan covered by a fidelity bond	2011-09-30	Yes
Value of fidelity bond cover	2011-09-30	$200,000
If this is an individual account plan, was there a blackout period	2011-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2011-09-30	No
Contributions received from participants	2011-09-30	$227,633
Participant contributions at end of year	2011-09-30	$11,347
Participant contributions at beginning of year	2011-09-30	$5,237
Participant contributions at end of year	2011-09-30	$8,586
Participant contributions at beginning of year	2011-09-30	$9,170
Assets. Other investments not covered elsewhere at end of year	2011-09-30	$0
Assets. Other investments not covered elsewhere at beginning of year	2011-09-30	$0
Income. Received or receivable in cash from other sources (including rollovers)	2011-09-30	$1,672
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-09-30	$23
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-09-30	$11
Assets. Loans (other than to participants) at end of year	2011-09-30	$0
Assets. Loans (other than to participants) at beginning of year	2011-09-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-09-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-09-30	$0
Liabilities. Value of operating payables at end of year	2011-09-30	$0
Liabilities. Value of operating payables at beginning of year	2011-09-30	$0
Total non interest bearing cash at end of year	2011-09-30	$0
Total non interest bearing cash at beginning of year	2011-09-30	$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	2011-09-30	No
Value of net income/loss	2011-09-30	$170,823
Value of net assets at end of year (total assets less liabilities)	2011-09-30	$1,227,184
Value of net assets at beginning of year (total assets less liabilities)	2011-09-30	$1,056,361
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-09-30	No
Were any leases to which the plan was party in default or uncollectible	2011-09-30	No
Assets. partnership/joint venture interests at end of year	2011-09-30	$0
Assets. partnership/joint venture interests at beginning of year	2011-09-30	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-09-30	$1,206,173
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-09-30	$1,041,026
Interest on participant loans	2011-09-30	$411
Value of interest in master investment trust accounts at end of year	2011-09-30	$0
Value of interest in master investment trust accounts at beginning of year	2011-09-30	$0
Value of interest in common/collective trusts at end of year	2011-09-30	$0
Value of interest in common/collective trusts at beginning of year	2011-09-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-09-30	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-09-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-09-30	$0
Assets. Value of investments in 103.12 investment entities at end of year	2011-09-30	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2011-09-30	$0
Asset value of US Government securities at end of year	2011-09-30	$0
Asset value of US Government securities at beginning of year	2011-09-30	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-09-30	$-44,922
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-09-30	No
Was there a failure to transmit to the plan any participant contributions	2011-09-30	No
Has the plan failed to provide any benefit when due under the plan	2011-09-30	No
Assets. Invements in employer securities at end of year	2011-09-30	$0
Assets. Invements in employer securities at beginning of year	2011-09-30	$0
Assets. Value of employer real property at end of year	2011-09-30	$0
Assets. Value of employer real property at beginning of year	2011-09-30	$0
Contributions received in cash from employer	2011-09-30	$60,471
Employer contributions (assets) at end of year	2011-09-30	$1,055
Employer contributions (assets) at beginning of year	2011-09-30	$917
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-09-30	$90,010
Asset. Corporate debt instrument preferred debt at end of year	2011-09-30	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2011-09-30	$0
Asset. Corporate debt instrument debt (other) at end of year	2011-09-30	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2011-09-30	$0
Contract administrator fees	2011-09-30	$6,169
Assets. Corporate common stocks other than exployer securities at end of year	2011-09-30	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-09-30	$0
Liabilities. Value of benefit claims payable at end of year	2011-09-30	$0
Liabilities. Value of benefit claims payable at beginning of year	2011-09-30	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2011-09-30	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2011-09-30	$0
Did the plan have assets held for investment	2011-09-30	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	2011-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-09-30	No
Aggregate proceeds on sale of assets	2011-09-30	$182,936
Aggregate carrying amount (costs) on sale of assets	2011-09-30	$177,353
Liabilities. Value of acquisition indebtedness at end of year	2011-09-30	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2011-09-30	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-09-30	No
Opinion of an independent qualified public accountant for this plan	2011-09-30	Unqualified
Accountancy firm name	2011-09-30	WEST & COMPANY, LLC
Accountancy firm EIN	2011-09-30	370980065
2010 : THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-09-30	$0

Form 5500 Responses for THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN

2012: THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	Yes
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Trust	Yes
2012-10-01	Plan benefit arrangement - Trust	Yes
2011: THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Trust	Yes
2011-10-01	Plan benefit arrangement - Trust	Yes
2009: THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	Yes
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan funding arrangement – Trust	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement - Trust	Yes
2008: THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME TAX DEFERRED ANNUITY PLAN 2008 form 5500 responses
2008-10-01	Type of plan entity	Single employer plan
2008-10-01	Submission has been amended	No
2008-10-01	This submission is the final filing	No
2008-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-10-01	Plan is a collectively bargained plan	No

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Company Name:	THE HOOPESTON COMMUNITY MEMORIAL HOSPITAL AND NURSING HOME
Employer identification number (EIN):	363637465

Plan id#	Filing Submission Date	Name of Administrator
001	2012-10-01	HARRY BROCKUS
001	2011-10-01	HARRY BROCKUS
001	2009-10-01	BETSY MORGENROTH
001	2009-10-01	BETSY MORGENROTH
001	2008-10-01