401k Plan data: THOMAS MEMORIAL HOSPITAL 401(K) PLAN plan

THOMAS MEMORIAL HOSPITAL 401(K) PLAN 401k Plan overview

Plan Name	THOMAS MEMORIAL HOSPITAL 401(K) PLAN
Plan identification number	003

THOMAS MEMORIAL HOSPITAL 401(K) 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

HERBERT J. MEMORIAL HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: HERBERT J. MEMORIAL HOSPITAL

Employer identification number (EIN): 550404900

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THOMAS MEMORIAL HOSPITAL 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2015-01-01 RENEE CROSS MARYBETH SMITH 2016-10-17
003 2014-01-01 RENEE CROSS MARYBETH SMITH 2015-10-13
003 2013-01-01 CHARLIE COVERT MARYBETH SMITH 2014-10-15
003 2012-07-01 MARYBETH SMITH CHARLES COVERT 2014-01-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
003	2015-01-01	RENEE CROSS	MARYBETH SMITH	2016-10-17
003	2014-01-01	RENEE CROSS	MARYBETH SMITH	2015-10-13
003	2013-01-01	CHARLIE COVERT	MARYBETH SMITH	2014-10-15
003	2012-07-01	MARYBETH SMITH	CHARLES COVERT	2014-01-15

Plan Statistics for THOMAS MEMORIAL HOSPITAL 401(K) PLAN

401k plan membership statisitcs for THOMAS MEMORIAL HOSPITAL 401(K) PLAN

Measure Date Value
2015: THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 843
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,334
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,049
Number of other retired or separated participants entitled to future benefits 2014-01-01 408
Total of all active and inactive participants 2014-01-01 1,457
Total participants 2014-01-01 1,457
Number of participants with account balances 2014-01-01 1,360
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 961
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 858
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 36
Total of all active and inactive participants 2013-01-01 894
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 894
Number of participants with account balances 2013-01-01 511
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 809
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 980
Number of retired or separated participants receiving benefits 2012-07-01 2
Number of other retired or separated participants entitled to future benefits 2012-07-01 11
Total of all active and inactive participants 2012-07-01 993
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 0
Total participants 2012-07-01 993
Number of participants with account balances 2012-07-01 494
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-01 0

Measure	Date	Value
2015: THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	843
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,334
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,049
Number of other retired or separated participants entitled to future benefits	2014-01-01	408
Total of all active and inactive participants	2014-01-01	1,457
Total participants	2014-01-01	1,457
Number of participants with account balances	2014-01-01	1,360
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	961
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	858
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	36
Total of all active and inactive participants	2013-01-01	894
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	894
Number of participants with account balances	2013-01-01	511
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	809
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	980
Number of retired or separated participants receiving benefits	2012-07-01	2
Number of other retired or separated participants entitled to future benefits	2012-07-01	11
Total of all active and inactive participants	2012-07-01	993
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	0
Total participants	2012-07-01	993
Number of participants with account balances	2012-07-01	494
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-01	0

Financial Data on THOMAS MEMORIAL HOSPITAL 401(K) PLAN

Measure	Date	Value
2015 : THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets from this plan	2015-12-31	$9,081,229
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$36,586
Total income from all sources (including contributions)	2015-12-31	$2,336,908
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$436,230
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$364,228
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$2,407,901
Value of total assets at end of year	2015-12-31	$0
Value of total assets at beginning of year	2015-12-31	$7,217,137
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$72,002
Total interest from all sources	2015-12-31	$5,042
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$452,839
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$1,665,436
Participant contributions at beginning of year	2015-12-31	$112,500
Participant contributions at beginning of year	2015-12-31	$75,781
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$103,111
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$36,586
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$1,900,678
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$7,180,551
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$7,016,626
Interest on participant loans	2015-12-31	$5,042
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-528,874
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$639,354
Employer contributions (assets) at beginning of year	2015-12-31	$12,230
Income. Dividends from common stock	2015-12-31	$452,839
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$364,228
Contract administrator fees	2015-12-31	$72,002
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	Yes
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	SUTTLE & STALNAKER, PLLC
Accountancy firm EIN	2015-12-31	558723494
2014 : THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$36,586
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$33,164
Total income from all sources (including contributions)	2014-12-31	$2,182,834
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$527,933
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$460,935
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,883,963
Value of total assets at end of year	2014-12-31	$7,217,137
Value of total assets at beginning of year	2014-12-31	$5,558,814
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$66,998
Total interest from all sources	2014-12-31	$4,640
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$359,210
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$1,552,200
Participant contributions at end of year	2014-12-31	$112,500
Participant contributions at beginning of year	2014-12-31	$115,441
Participant contributions at end of year	2014-12-31	$75,781
Participant contributions at beginning of year	2014-12-31	$77,314
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$15,109
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$49,387
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$36,586
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$33,164
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$1,654,901
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$7,180,551
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$5,525,650
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$7,016,626
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$5,303,905
Interest on participant loans	2014-12-31	$4,640
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$-64,979
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$316,654
Employer contributions (assets) at end of year	2014-12-31	$12,230
Employer contributions (assets) at beginning of year	2014-12-31	$12,767
Income. Dividends from common stock	2014-12-31	$359,210
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$460,935
Contract administrator fees	2014-12-31	$66,998
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	SUTTLE & STALNAKER, PLLC
Accountancy firm EIN	2014-12-31	558723494
2013 : THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$33,164
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$21,210
Total income from all sources (including contributions)	2013-12-31	$2,913,668
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$109,709
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$54,481
Value of total corrective distributions	2013-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$2,150,055
Value of total assets at end of year	2013-12-31	$5,558,814
Value of total assets at beginning of year	2013-12-31	$2,742,901
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$55,228
Total interest from all sources	2013-12-31	$2,107
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$175,935
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
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
Contributions received from participants	2013-12-31	$1,594,786
Participant contributions at end of year	2013-12-31	$115,441
Participant contributions at beginning of year	2013-12-31	$41,407
Participant contributions at end of year	2013-12-31	$77,314
Participant contributions at beginning of year	2013-12-31	$60,311
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$233,194
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$49,387
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$33,164
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$21,210
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	$2,803,959
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$5,525,650
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,721,691
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	$5,303,905
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$2,629,169
Interest on participant loans	2013-12-31	$2,107
Interest earned on other investments	2013-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$585,571
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	$322,075
Employer contributions (assets) at end of year	2013-12-31	$12,767
Employer contributions (assets) at beginning of year	2013-12-31	$12,014
Income. Dividends from common stock	2013-12-31	$175,935
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$54,481
Contract administrator fees	2013-12-31	$55,228
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
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
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	SUTTLE & STALNAKER, PLLC
Accountancy firm EIN	2013-12-31	558723494
2012 : THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$21,210
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$2,732,467
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$10,776
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$146
Value of total corrective distributions	2012-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$2,639,292
Value of total assets at end of year	2012-12-31	$2,742,901
Value of total assets at beginning of year	2012-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$10,630
Total interest from all sources	2012-12-31	$347
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$48,172
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$48,172
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
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
Contributions received from participants	2012-12-31	$789,409
Participant contributions at end of year	2012-12-31	$41,407
Participant contributions at end of year	2012-12-31	$60,311
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$1,696,664
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$21,210
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	$2,721,691
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,721,691
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$2,629,169
Interest on participant loans	2012-12-31	$347
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$44,656
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	$153,219
Employer contributions (assets) at end of year	2012-12-31	$12,014
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$146
Contract administrator fees	2012-12-31	$10,630
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	SUTTLE & STALNAKER, PLLC
Accountancy firm EIN	2012-12-31	558723494

Form 5500 Responses for THOMAS MEMORIAL HOSPITAL 401(K) PLAN

2015: THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	Yes
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: THOMAS MEMORIAL HOSPITAL 401(K) PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	First time form 5500 has been submitted	Yes
2012-07-01	Submission has been amended	Yes
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

70676

Policy instance

Insurance contract or identification number	70676
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

70676

Policy instance

Insurance contract or identification number	70676
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

70676

Policy instance

Insurance contract or identification number	70676
Number of Individuals Covered	0
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

THOMAS MEMORIAL HOSPITAL FLEXIBLE BENEFITS PLAN [EIN = 260440674]

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Company Name:	HERBERT J. MEMORIAL HOSPITAL
Employer identification number (EIN):	550404900
NAIC Classification:	622000
NAIC Description:	Hospitals