401k Plan data: HENRY MEDICAL CENTER RETIREMENT PLAN plan

HENRY MEDICAL CENTER RETIREMENT PLAN 401k Plan overview

Plan Name	HENRY MEDICAL CENTER RETIREMENT PLAN
Plan identification number	001

HENRY MEDICAL CENTER RETIREMENT 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(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.
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

HENRY MEDICAL CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: HENRY MEDICAL CENTER, INC.

Employer identification number (EIN): 582200195

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HENRY MEDICAL CENTER RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-01-01 VICKI A CANSLER VICKI A CANSLER 2013-10-14
001 2011-01-01 MARIBETH C LEDFORD MARIBETH C LEDFORD 2012-10-15
001 2009-01-01 MARIBETH LEDFORD MARIBETH LEDFORD 2010-10-15
001 2009-01-01 MARIBETH C. LEDFORD
001 2009-01-01 MARIBETH C. LEDFORD MARIBETH C. LEDFORD 2011-11-04

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2012-01-01	VICKI A CANSLER	VICKI A CANSLER	2013-10-14
001	2011-01-01	MARIBETH C LEDFORD	MARIBETH C LEDFORD	2012-10-15
001	2009-01-01	MARIBETH LEDFORD	MARIBETH LEDFORD	2010-10-15
001	2009-01-01	MARIBETH C. LEDFORD
001	2009-01-01	MARIBETH C. LEDFORD	MARIBETH C. LEDFORD	2011-11-04

Plan Statistics for HENRY MEDICAL CENTER RETIREMENT PLAN

401k plan membership statisitcs for HENRY MEDICAL CENTER RETIREMENT PLAN

Measure Date Value
2012: HENRY MEDICAL CENTER RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,158
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 0
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: HENRY MEDICAL CENTER RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,651
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,072
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 83
Total of all active and inactive participants 2011-01-01 1,157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 1,158
Number of participants with account balances 2011-01-01 1,103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 3
2009: HENRY MEDICAL CENTER RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,383
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,220
Number of retired or separated participants receiving benefits 2009-01-01 2
Number of other retired or separated participants entitled to future benefits 2009-01-01 90
Total of all active and inactive participants 2009-01-01 1,312
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 2
Total participants 2009-01-01 1,314
Number of participants with account balances 2009-01-01 1,280
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 42

Measure	Date	Value
2012: HENRY MEDICAL CENTER RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,158
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	0
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: HENRY MEDICAL CENTER RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,651
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,072
Number of retired or separated participants receiving benefits	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	83
Total of all active and inactive participants	2011-01-01	1,157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	1,158
Number of participants with account balances	2011-01-01	1,103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	3
2009: HENRY MEDICAL CENTER RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,383
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,220
Number of retired or separated participants receiving benefits	2009-01-01	2
Number of other retired or separated participants entitled to future benefits	2009-01-01	90
Total of all active and inactive participants	2009-01-01	1,312
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	2
Total participants	2009-01-01	1,314
Number of participants with account balances	2009-01-01	1,280
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	42

Financial Data on HENRY MEDICAL CENTER RETIREMENT PLAN

Measure	Date	Value
2012 : HENRY MEDICAL CENTER RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total transfer of assets from this plan	2012-12-31	$8,495,112
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$10,461
Total income from all sources (including contributions)	2012-12-31	$656,876
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$1,022,810
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$995,941
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$0
Value of total assets at end of year	2012-12-31	$0
Value of total assets at beginning of year	2012-12-31	$8,871,507
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$26,869
Total interest from all sources	2012-12-31	$71,611
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$75,227
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2012-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$75,227
Administrative expenses professional fees incurred	2012-12-31	$18,887
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$10,461
Liabilities. Value of operating payables at beginning of year	2012-12-31	$10,461
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	$-365,934
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$8,861,046
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 beginning of year	2012-12-31	$4,539,046
Interest earned on other investments	2012-12-31	$71,608
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$16,361
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$16,361
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$3
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$4,305,639
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$510,038
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$995,941
Contract administrator fees	2012-12-31	$7,982
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	Yes
Did the plan have assets held for investment	2012-12-31	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	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	Yes
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	FRAZIER DEETER, LLC
Accountancy firm EIN	2012-12-31	581433845
2011 : HENRY MEDICAL CENTER RETIREMENT 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	$10,461
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$10,381
Total income from all sources (including contributions)	2011-12-31	$73,642
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$733,532
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$668,780
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$0
Value of total assets at end of year	2011-12-31	$8,871,507
Value of total assets at beginning of year	2011-12-31	$9,531,317
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$64,752
Total interest from all sources	2011-12-31	$80,869
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$113,020
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$113,020
Administrative expenses professional fees incurred	2011-12-31	$35,746
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
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
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$10,461
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$10,379
Liabilities. Value of operating payables at end of year	2011-12-31	$10,461
Liabilities. Value of operating payables at beginning of year	2011-12-31	$10,381
Total non interest bearing cash at beginning of year	2011-12-31	$6,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-659,890
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$8,861,046
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$9,520,936
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	$4,539,046
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$4,931,615
Interest earned on other investments	2011-12-31	$80,869
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$16,361
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$10,140
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$10,140
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$4,305,639
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$4,573,183
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-120,247
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$668,780
Contract administrator fees	2011-12-31	$29,006
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	FRAZIER DEETER, LLC
Accountancy firm EIN	2011-12-31	581433845
2010 : HENRY MEDICAL CENTER RETIREMENT 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	$10,381
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$11,984
Total income from all sources (including contributions)	2010-12-31	$761,496
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$509,048
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$483,872
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	$9,531,317
Value of total assets at beginning of year	2010-12-31	$9,280,472
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$25,176
Total interest from all sources	2010-12-31	$119,707
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$81,258
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$81,258
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
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
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$10,379
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$11,985
Other income not declared elsewhere	2010-12-31	$-17,296
Liabilities. Value of operating payables at end of year	2010-12-31	$10,381
Liabilities. Value of operating payables at beginning of year	2010-12-31	$11,984
Total non interest bearing cash at end of year	2010-12-31	$6,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$252,448
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$9,520,936
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$9,268,488
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
Investment advisory and management fees	2010-12-31	$18,000
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$4,931,615
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$4,876,721
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$2,003
Interest earned on other investments	2010-12-31	$119,705
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$10,140
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$8,850
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$8,850
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$2
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$4,573,183
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$4,380,913
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$577,827
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
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	$483,872
Contract administrator fees	2010-12-31	$7,176
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
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	FRAZIER DEETER, LLC
Accountancy firm EIN	2010-12-31	581433845
2009 : HENRY MEDICAL CENTER RETIREMENT PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for HENRY MEDICAL CENTER RETIREMENT PLAN

2012: HENRY MEDICAL CENTER RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	Yes
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
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: HENRY MEDICAL CENTER RETIREMENT 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 – 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
2009: HENRY MEDICAL CENTER RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	HENRY MEDICAL CENTER, INC.
Employer identification number (EIN):	582200195
NAIC Classification:	622000
NAIC Description:	Hospitals