401k Plan data: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN plan

LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 401k Plan overview

Plan Name	LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN
Plan identification number	001

LAWRENCE COUNTY MEMORIAL HOSPITAL 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(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.
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.

401k Sponsoring company profile

LAWRENCE COUNTY MEMORIAL HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: LAWRENCE COUNTY MEMORIAL HOSPITAL

Employer identification number (EIN): 800618988

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-07-01 TAMARA KOCHER 2022-04-13
001 2019-07-01 TAMARA KOCHER 2021-04-13
001 2018-07-01 TAMARA KOCHER 2020-04-13
001 2017-07-01 TAMARA KOCHER 2019-04-11
001 2016-07-01
001 2015-07-01
001 2014-07-01
001 2013-07-01 TAMARA L. KOCHER
001 2012-07-01 TAMARA L. KOCHER
001 2011-07-01 TAMARA L.KOCHER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2020-07-01	TAMARA KOCHER	2022-04-13
001	2019-07-01	TAMARA KOCHER	2021-04-13
001	2018-07-01	TAMARA KOCHER	2020-04-13
001	2017-07-01	TAMARA KOCHER	2019-04-11
001	2016-07-01
001	2015-07-01
001	2014-07-01
001	2013-07-01	TAMARA L. KOCHER
001	2012-07-01	TAMARA L. KOCHER
001	2011-07-01	TAMARA L.KOCHER

Plan Statistics for LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN

401k plan membership statisitcs for LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN

Measure Date Value
2020: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 206
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 176
Number of retired or separated participants receiving benefits 2020-07-01 15
Number of other retired or separated participants entitled to future benefits 2020-07-01 30
Total of all active and inactive participants 2020-07-01 221
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-07-01 0
Total participants 2020-07-01 221
Number of participants with account balances 2020-07-01 146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-07-01 2
2019: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 204
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 166
Number of retired or separated participants receiving benefits 2019-07-01 12
Number of other retired or separated participants entitled to future benefits 2019-07-01 26
Total of all active and inactive participants 2019-07-01 204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-07-01 0
Total participants 2019-07-01 204
Number of participants with account balances 2019-07-01 133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-07-01 2
2018: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 196
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 172
Number of retired or separated participants receiving benefits 2018-07-01 10
Number of other retired or separated participants entitled to future benefits 2018-07-01 21
Total of all active and inactive participants 2018-07-01 203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-07-01 0
Total participants 2018-07-01 203
Number of participants with account balances 2018-07-01 123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-07-01 2
2017: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 202
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 169
Number of retired or separated participants receiving benefits 2017-07-01 5
Number of other retired or separated participants entitled to future benefits 2017-07-01 22
Total of all active and inactive participants 2017-07-01 196
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-07-01 0
Total participants 2017-07-01 196
Number of participants with account balances 2017-07-01 121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-07-01 2
2016: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 198
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 169
Number of retired or separated participants receiving benefits 2016-07-01 5
Number of other retired or separated participants entitled to future benefits 2016-07-01 24
Total of all active and inactive participants 2016-07-01 198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-07-01 0
Total participants 2016-07-01 198
Number of participants with account balances 2016-07-01 120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-07-01 4
2015: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 186
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 169
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 26
Total of all active and inactive participants 2015-07-01 195
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-07-01 0
Total participants 2015-07-01 195
Number of participants with account balances 2015-07-01 195
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-07-01 2
2014: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 173
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 158
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 28
Total of all active and inactive participants 2014-07-01 186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-07-01 0
Total participants 2014-07-01 186
Number of participants with account balances 2014-07-01 126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-07-01 1
2013: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 168
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 152
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 21
Total of all active and inactive participants 2013-07-01 173
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-07-01 0
Total participants 2013-07-01 173
Number of participants with account balances 2013-07-01 120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-07-01 1
2012: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 154
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 148
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 20
Total of all active and inactive participants 2012-07-01 168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 0
Total participants 2012-07-01 168
Number of participants with account balances 2012-07-01 117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-01 4
2011: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 144
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 145
Number of retired or separated participants receiving benefits 2011-07-01 0
Number of other retired or separated participants entitled to future benefits 2011-07-01 9
Total of all active and inactive participants 2011-07-01 154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 154
Number of participants with account balances 2011-07-01 121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 6

Measure	Date	Value
2020: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	206
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	176
Number of retired or separated participants receiving benefits	2020-07-01	15
Number of other retired or separated participants entitled to future benefits	2020-07-01	30
Total of all active and inactive participants	2020-07-01	221
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-07-01	0
Total participants	2020-07-01	221
Number of participants with account balances	2020-07-01	146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-07-01	2
2019: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	204
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	166
Number of retired or separated participants receiving benefits	2019-07-01	12
Number of other retired or separated participants entitled to future benefits	2019-07-01	26
Total of all active and inactive participants	2019-07-01	204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-07-01	0
Total participants	2019-07-01	204
Number of participants with account balances	2019-07-01	133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-07-01	2
2018: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	196
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	172
Number of retired or separated participants receiving benefits	2018-07-01	10
Number of other retired or separated participants entitled to future benefits	2018-07-01	21
Total of all active and inactive participants	2018-07-01	203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-07-01	0
Total participants	2018-07-01	203
Number of participants with account balances	2018-07-01	123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-07-01	2
2017: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	202
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	169
Number of retired or separated participants receiving benefits	2017-07-01	5
Number of other retired or separated participants entitled to future benefits	2017-07-01	22
Total of all active and inactive participants	2017-07-01	196
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-07-01	0
Total participants	2017-07-01	196
Number of participants with account balances	2017-07-01	121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-07-01	2
2016: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	198
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	169
Number of retired or separated participants receiving benefits	2016-07-01	5
Number of other retired or separated participants entitled to future benefits	2016-07-01	24
Total of all active and inactive participants	2016-07-01	198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-07-01	0
Total participants	2016-07-01	198
Number of participants with account balances	2016-07-01	120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-07-01	4
2015: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	186
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	169
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	26
Total of all active and inactive participants	2015-07-01	195
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-07-01	0
Total participants	2015-07-01	195
Number of participants with account balances	2015-07-01	195
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-07-01	2
2014: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	173
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	158
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	28
Total of all active and inactive participants	2014-07-01	186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-07-01	0
Total participants	2014-07-01	186
Number of participants with account balances	2014-07-01	126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-07-01	1
2013: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	168
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	152
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	21
Total of all active and inactive participants	2013-07-01	173
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-07-01	0
Total participants	2013-07-01	173
Number of participants with account balances	2013-07-01	120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-07-01	1
2012: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	154
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	148
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	20
Total of all active and inactive participants	2012-07-01	168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	0
Total participants	2012-07-01	168
Number of participants with account balances	2012-07-01	117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-01	4
2011: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	144
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	145
Number of retired or separated participants receiving benefits	2011-07-01	0
Number of other retired or separated participants entitled to future benefits	2011-07-01	9
Total of all active and inactive participants	2011-07-01	154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	154
Number of participants with account balances	2011-07-01	121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	6

Financial Data on LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN

Measure	Date	Value
2021 : LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-06-30	$0
Total income from all sources (including contributions)	2021-06-30	$1,541,007
Total loss/gain on sale of assets	2021-06-30	$0
Total of all expenses incurred	2021-06-30	$331,192
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-06-30	$327,971
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-06-30	$509,928
Value of total assets at end of year	2021-06-30	$4,483,527
Value of total assets at beginning of year	2021-06-30	$3,273,712
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-06-30	$3,221
Total interest from all sources	2021-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2021-06-30	$188,053
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-06-30	$188,053
Administrative expenses professional fees incurred	2021-06-30	$3,221
Was this plan covered by a fidelity bond	2021-06-30	Yes
Value of fidelity bond cover	2021-06-30	$500,000
If this is an individual account plan, was there a blackout period	2021-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2021-06-30	No
Contributions received from participants	2021-06-30	$370,655
Income. Received or receivable in cash from other sources (including rollovers)	2021-06-30	$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	2021-06-30	No
Value of net income/loss	2021-06-30	$1,209,815
Value of net assets at end of year (total assets less liabilities)	2021-06-30	$4,483,527
Value of net assets at beginning of year (total assets less liabilities)	2021-06-30	$3,273,712
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-06-30	No
Were any leases to which the plan was party in default or uncollectible	2021-06-30	No
Value of interest in pooled separate accounts at end of year	2021-06-30	$4,483,527
Value of interest in pooled separate accounts at beginning of year	2021-06-30	$3,273,712
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-06-30	$843,026
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-06-30	No
Was there a failure to transmit to the plan any participant contributions	2021-06-30	No
Has the plan failed to provide any benefit when due under the plan	2021-06-30	No
Contributions received in cash from employer	2021-06-30	$139,273
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-06-30	$327,971
Did the plan have assets held for investment	2021-06-30	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	2021-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-06-30	No
Opinion of an independent qualified public accountant for this plan	2021-06-30	Disclaimer
Accountancy firm name	2021-06-30	KERBER, ECK & BRAECKEL LLP
Accountancy firm EIN	2021-06-30	430352985
2020 : LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$0
Total income from all sources (including contributions)	2020-06-30	$579,772
Total loss/gain on sale of assets	2020-06-30	$0
Total of all expenses incurred	2020-06-30	$294,329
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-06-30	$291,168
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-06-30	$552,326
Value of total assets at end of year	2020-06-30	$3,273,712
Value of total assets at beginning of year	2020-06-30	$2,988,269
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-06-30	$3,161
Total interest from all sources	2020-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2020-06-30	$152,378
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-06-30	$152,378
Administrative expenses professional fees incurred	2020-06-30	$3,161
Was this plan covered by a fidelity bond	2020-06-30	Yes
Value of fidelity bond cover	2020-06-30	$500,000
If this is an individual account plan, was there a blackout period	2020-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2020-06-30	No
Contributions received from participants	2020-06-30	$322,746
Income. Received or receivable in cash from other sources (including rollovers)	2020-06-30	$107,851
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Value of net income/loss	2020-06-30	$285,443
Value of net assets at end of year (total assets less liabilities)	2020-06-30	$3,273,712
Value of net assets at beginning of year (total assets less liabilities)	2020-06-30	$2,988,269
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-06-30	No
Were any leases to which the plan was party in default or uncollectible	2020-06-30	No
Value of interest in pooled separate accounts at end of year	2020-06-30	$3,273,712
Value of interest in pooled separate accounts at beginning of year	2020-06-30	$2,988,269
Net investment gain/loss from pooled separate accounts	2020-06-30	$-124,932
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-06-30	No
Was there a failure to transmit to the plan any participant contributions	2020-06-30	Yes
Has the plan failed to provide any benefit when due under the plan	2020-06-30	No
Contributions received in cash from employer	2020-06-30	$121,729
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-06-30	$291,168
Did the plan have assets held for investment	2020-06-30	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	2020-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2020-06-30	Disclaimer
Accountancy firm name	2020-06-30	KERBER, ECK & BRAECKEL LLP
Accountancy firm EIN	2020-06-30	430352985
2019 : LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$0
Total income from all sources (including contributions)	2019-06-30	$650,430
Total loss/gain on sale of assets	2019-06-30	$0
Total of all expenses incurred	2019-06-30	$409,805
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-06-30	$405,306
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-06-30	$502,632
Value of total assets at end of year	2019-06-30	$2,988,269
Value of total assets at beginning of year	2019-06-30	$2,747,644
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-06-30	$4,499
Total interest from all sources	2019-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-06-30	$155,932
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-06-30	$155,932
Administrative expenses professional fees incurred	2019-06-30	$4,017
Was this plan covered by a fidelity bond	2019-06-30	Yes
Value of fidelity bond cover	2019-06-30	$300,000
If this is an individual account plan, was there a blackout period	2019-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2019-06-30	No
Contributions received from participants	2019-06-30	$298,825
Income. Received or receivable in cash from other sources (including rollovers)	2019-06-30	$86,206
Administrative expenses (other) incurred	2019-06-30	$482
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-06-30	No
Value of net income/loss	2019-06-30	$240,625
Value of net assets at end of year (total assets less liabilities)	2019-06-30	$2,988,269
Value of net assets at beginning of year (total assets less liabilities)	2019-06-30	$2,747,644
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-06-30	No
Were any leases to which the plan was party in default or uncollectible	2019-06-30	No
Value of interest in pooled separate accounts at end of year	2019-06-30	$2,988,269
Value of interest in pooled separate accounts at beginning of year	2019-06-30	$2,747,644
Net investment gain/loss from pooled separate accounts	2019-06-30	$-8,134
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-06-30	No
Was there a failure to transmit to the plan any participant contributions	2019-06-30	No
Has the plan failed to provide any benefit when due under the plan	2019-06-30	No
Contributions received in cash from employer	2019-06-30	$117,601
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-06-30	$405,306
Did the plan have assets held for investment	2019-06-30	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	2019-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2019-06-30	Disclaimer
Accountancy firm name	2019-06-30	KERBER, ECK & BRAECKEL LLP
Accountancy firm EIN	2019-06-30	430352985
2018 : LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-06-30	$0
Total income from all sources (including contributions)	2018-06-30	$576,356
Total loss/gain on sale of assets	2018-06-30	$0
Total of all expenses incurred	2018-06-30	$276,645
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-06-30	$272,793
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-06-30	$421,286
Value of total assets at end of year	2018-06-30	$2,747,644
Value of total assets at beginning of year	2018-06-30	$2,447,933
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-06-30	$3,852
Total interest from all sources	2018-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-06-30	No
Administrative expenses professional fees incurred	2018-06-30	$3,105
Was this plan covered by a fidelity bond	2018-06-30	Yes
Value of fidelity bond cover	2018-06-30	$300,000
If this is an individual account plan, was there a blackout period	2018-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2018-06-30	No
Contributions received from participants	2018-06-30	$297,613
Income. Received or receivable in cash from other sources (including rollovers)	2018-06-30	$13,162
Administrative expenses (other) incurred	2018-06-30	$747
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-06-30	No
Value of net income/loss	2018-06-30	$299,711
Value of net assets at end of year (total assets less liabilities)	2018-06-30	$2,747,644
Value of net assets at beginning of year (total assets less liabilities)	2018-06-30	$2,447,933
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-06-30	No
Were any leases to which the plan was party in default or uncollectible	2018-06-30	No
Value of interest in pooled separate accounts at end of year	2018-06-30	$2,747,644
Value of interest in pooled separate accounts at beginning of year	2018-06-30	$2,447,933
Net investment gain/loss from pooled separate accounts	2018-06-30	$155,070
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-06-30	No
Was there a failure to transmit to the plan any participant contributions	2018-06-30	No
Has the plan failed to provide any benefit when due under the plan	2018-06-30	No
Contributions received in cash from employer	2018-06-30	$110,511
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-06-30	$272,793
Did the plan have assets held for investment	2018-06-30	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	2018-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2018-06-30	Disclaimer
Accountancy firm name	2018-06-30	KERBER, ECK & BRAECKEL LLP
Accountancy firm EIN	2018-06-30	430352985
2017 : LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$0
Total income from all sources (including contributions)	2017-06-30	$709,195
Total loss/gain on sale of assets	2017-06-30	$0
Total of all expenses incurred	2017-06-30	$245,533
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-06-30	$241,122
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-06-30	$417,602
Value of total assets at end of year	2017-06-30	$2,447,933
Value of total assets at beginning of year	2017-06-30	$1,984,271
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-06-30	$4,411
Total interest from all sources	2017-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-06-30	No
Administrative expenses professional fees incurred	2017-06-30	$4,411
Was this plan covered by a fidelity bond	2017-06-30	Yes
Value of fidelity bond cover	2017-06-30	$300,000
If this is an individual account plan, was there a blackout period	2017-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2017-06-30	No
Contributions received from participants	2017-06-30	$302,677
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-06-30	No
Value of net income/loss	2017-06-30	$463,662
Value of net assets at end of year (total assets less liabilities)	2017-06-30	$2,447,933
Value of net assets at beginning of year (total assets less liabilities)	2017-06-30	$1,984,271
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-06-30	No
Were any leases to which the plan was party in default or uncollectible	2017-06-30	No
Value of interest in pooled separate accounts at end of year	2017-06-30	$2,447,933
Value of interest in pooled separate accounts at beginning of year	2017-06-30	$1,984,271
Net investment gain/loss from pooled separate accounts	2017-06-30	$291,593
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-06-30	No
Was there a failure to transmit to the plan any participant contributions	2017-06-30	No
Has the plan failed to provide any benefit when due under the plan	2017-06-30	No
Contributions received in cash from employer	2017-06-30	$114,925
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-06-30	$241,122
Did the plan have assets held for investment	2017-06-30	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	2017-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2017-06-30	Disclaimer
Accountancy firm name	2017-06-30	KERBER, ECK & BRAECKEL LLP
Accountancy firm EIN	2017-06-30	430352985
2016 : LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$0
Total income from all sources (including contributions)	2016-06-30	$405,976
Total loss/gain on sale of assets	2016-06-30	$0
Total of all expenses incurred	2016-06-30	$164,277
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-06-30	$159,707
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-06-30	$435,159
Value of total assets at end of year	2016-06-30	$1,984,271
Value of total assets at beginning of year	2016-06-30	$1,742,572
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-06-30	$4,570
Total interest from all sources	2016-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-06-30	No
Administrative expenses professional fees incurred	2016-06-30	$4,570
Was this plan covered by a fidelity bond	2016-06-30	Yes
Value of fidelity bond cover	2016-06-30	$300,000
If this is an individual account plan, was there a blackout period	2016-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2016-06-30	No
Contributions received from participants	2016-06-30	$322,328
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-06-30	No
Value of net income/loss	2016-06-30	$241,699
Value of net assets at end of year (total assets less liabilities)	2016-06-30	$1,984,271
Value of net assets at beginning of year (total assets less liabilities)	2016-06-30	$1,742,572
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-06-30	No
Were any leases to which the plan was party in default or uncollectible	2016-06-30	No
Value of interest in pooled separate accounts at end of year	2016-06-30	$1,984,271
Value of interest in pooled separate accounts at beginning of year	2016-06-30	$1,742,572
Net investment gain/loss from pooled separate accounts	2016-06-30	$-29,183
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-06-30	No
Was there a failure to transmit to the plan any participant contributions	2016-06-30	No
Has the plan failed to provide any benefit when due under the plan	2016-06-30	No
Contributions received in cash from employer	2016-06-30	$112,831
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-06-30	$159,707
Did the plan have assets held for investment	2016-06-30	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	2016-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2016-06-30	Disclaimer
Accountancy firm name	2016-06-30	KERBER, ECK & BRAECKEL LLP
Accountancy firm EIN	2016-06-30	430352985
2015 : LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$0
Total income from all sources (including contributions)	2015-06-30	$402,771
Total loss/gain on sale of assets	2015-06-30	$0
Total of all expenses incurred	2015-06-30	$145,306
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-06-30	$140,839
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-06-30	$377,319
Value of total assets at end of year	2015-06-30	$1,742,572
Value of total assets at beginning of year	2015-06-30	$1,485,107
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-06-30	$4,467
Total interest from all sources	2015-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-06-30	No
Administrative expenses professional fees incurred	2015-06-30	$4,467
Was this plan covered by a fidelity bond	2015-06-30	Yes
Value of fidelity bond cover	2015-06-30	$300,000
If this is an individual account plan, was there a blackout period	2015-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2015-06-30	No
Contributions received from participants	2015-06-30	$280,103
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-06-30	No
Value of net income/loss	2015-06-30	$257,465
Value of net assets at end of year (total assets less liabilities)	2015-06-30	$1,742,572
Value of net assets at beginning of year (total assets less liabilities)	2015-06-30	$1,485,107
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-06-30	No
Were any leases to which the plan was party in default or uncollectible	2015-06-30	No
Value of interest in pooled separate accounts at end of year	2015-06-30	$1,742,572
Value of interest in pooled separate accounts at beginning of year	2015-06-30	$1,485,107
Net investment gain/loss from pooled separate accounts	2015-06-30	$25,452
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-06-30	No
Was there a failure to transmit to the plan any participant contributions	2015-06-30	No
Has the plan failed to provide any benefit when due under the plan	2015-06-30	No
Contributions received in cash from employer	2015-06-30	$97,216
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-06-30	$140,839
Did the plan have assets held for investment	2015-06-30	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	2015-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2015-06-30	Disclaimer
Accountancy firm name	2015-06-30	KERBER, ECK & BRAECKEL LLP
Accountancy firm EIN	2015-06-30	430352985
2014 : LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$0
Total income from all sources (including contributions)	2014-06-30	$597,427
Total loss/gain on sale of assets	2014-06-30	$0
Total of all expenses incurred	2014-06-30	$41,020
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-06-30	$38,575
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-06-30	$430,490
Value of total assets at end of year	2014-06-30	$1,485,107
Value of total assets at beginning of year	2014-06-30	$928,700
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-06-30	$2,445
Total interest from all sources	2014-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-06-30	No
Administrative expenses professional fees incurred	2014-06-30	$2,445
Was this plan covered by a fidelity bond	2014-06-30	Yes
Value of fidelity bond cover	2014-06-30	$300,000
If this is an individual account plan, was there a blackout period	2014-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2014-06-30	No
Contributions received from participants	2014-06-30	$278,100
Income. Received or receivable in cash from other sources (including rollovers)	2014-06-30	$55,740
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-06-30	No
Value of net income/loss	2014-06-30	$556,407
Value of net assets at end of year (total assets less liabilities)	2014-06-30	$1,485,107
Value of net assets at beginning of year (total assets less liabilities)	2014-06-30	$928,700
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-06-30	No
Were any leases to which the plan was party in default or uncollectible	2014-06-30	No
Value of interest in pooled separate accounts at end of year	2014-06-30	$1,485,107
Value of interest in pooled separate accounts at beginning of year	2014-06-30	$928,700
Net investment gain/loss from pooled separate accounts	2014-06-30	$166,937
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-06-30	No
Was there a failure to transmit to the plan any participant contributions	2014-06-30	No
Has the plan failed to provide any benefit when due under the plan	2014-06-30	No
Contributions received in cash from employer	2014-06-30	$96,650
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-06-30	$38,575
Did the plan have assets held for investment	2014-06-30	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	2014-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2014-06-30	Disclaimer
Accountancy firm name	2014-06-30	BKD, LLP
Accountancy firm EIN	2014-06-30	440160260
2013 : LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$0
Total income from all sources (including contributions)	2013-06-30	$481,435
Total loss/gain on sale of assets	2013-06-30	$0
Total of all expenses incurred	2013-06-30	$24,434
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-06-30	$21,425
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-06-30	$407,454
Value of total assets at end of year	2013-06-30	$928,700
Value of total assets at beginning of year	2013-06-30	$471,699
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-06-30	$3,009
Total interest from all sources	2013-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-06-30	No
Was this plan covered by a fidelity bond	2013-06-30	Yes
Value of fidelity bond cover	2013-06-30	$300,000
If this is an individual account plan, was there a blackout period	2013-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2013-06-30	No
Contributions received from participants	2013-06-30	$289,297
Income. Received or receivable in cash from other sources (including rollovers)	2013-06-30	$16,175
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-06-30	No
Value of net income/loss	2013-06-30	$457,001
Value of net assets at end of year (total assets less liabilities)	2013-06-30	$928,700
Value of net assets at beginning of year (total assets less liabilities)	2013-06-30	$471,699
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-06-30	No
Were any leases to which the plan was party in default or uncollectible	2013-06-30	No
Investment advisory and management fees	2013-06-30	$3,009
Value of interest in pooled separate accounts at end of year	2013-06-30	$928,700
Value of interest in pooled separate accounts at beginning of year	2013-06-30	$471,699
Net investment gain/loss from pooled separate accounts	2013-06-30	$73,981
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-06-30	No
Was there a failure to transmit to the plan any participant contributions	2013-06-30	No
Has the plan failed to provide any benefit when due under the plan	2013-06-30	No
Contributions received in cash from employer	2013-06-30	$101,982
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-06-30	$21,425
Did the plan have assets held for investment	2013-06-30	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	2013-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2013-06-30	Disclaimer
Accountancy firm name	2013-06-30	BKD, LLP
Accountancy firm EIN	2013-06-30	440160260
2012 : LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$0
Total income from all sources (including contributions)	2012-06-30	$486,687
Total loss/gain on sale of assets	2012-06-30	$0
Total of all expenses incurred	2012-06-30	$14,988
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$12,486
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$476,279
Value of total assets at end of year	2012-06-30	$471,699
Value of total assets at beginning of year	2012-06-30	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$2,502
Total interest from all sources	2012-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	No
Was this plan covered by a fidelity bond	2012-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Contributions received from participants	2012-06-30	$266,268
Income. Received or receivable in cash from other sources (including rollovers)	2012-06-30	$135,719
Total non interest bearing cash at end of year	2012-06-30	$0
Total non interest bearing cash at beginning of year	2012-06-30	$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	2012-06-30	No
Value of net income/loss	2012-06-30	$471,699
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$471,699
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-06-30	No
Were any leases to which the plan was party in default or uncollectible	2012-06-30	No
Investment advisory and management fees	2012-06-30	$2,502
Value of interest in pooled separate accounts at end of year	2012-06-30	$471,699
Value of interest in pooled separate accounts at beginning of year	2012-06-30	$0
Net investment gain/loss from pooled separate accounts	2012-06-30	$10,408
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-06-30	No
Was there a failure to transmit to the plan any participant contributions	2012-06-30	No
Has the plan failed to provide any benefit when due under the plan	2012-06-30	No
Contributions received in cash from employer	2012-06-30	$74,292
Employer contributions (assets) at end of year	2012-06-30	$0
Employer contributions (assets) at beginning of year	2012-06-30	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-06-30	$12,486
Did the plan have assets held for investment	2012-06-30	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	2012-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2012-06-30	Disclaimer
Accountancy firm name	2012-06-30	BKD, LLP
Accountancy firm EIN	2012-06-30	440160260

Form 5500 Responses for LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN

2020: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Submission has been amended	No
2020-07-01	This submission is the final filing	No
2020-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-07-01	Plan is a collectively bargained plan	No
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan funding arrangement – Trust	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement - Trust	Yes
2019: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Submission has been amended	No
2019-07-01	This submission is the final filing	No
2019-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-07-01	Plan is a collectively bargained plan	No
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan funding arrangement – Trust	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement - Trust	Yes
2018: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Submission has been amended	No
2018-07-01	This submission is the final filing	No
2018-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-07-01	Plan is a collectively bargained plan	No
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan funding arrangement – Trust	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement - Trust	Yes
2017: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Submission has been amended	No
2017-07-01	This submission is the final filing	No
2017-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-07-01	Plan is a collectively bargained plan	No
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan funding arrangement – Trust	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement - Trust	Yes
2016: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan funding arrangement – Trust	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement - Trust	Yes
2015: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan funding arrangement – Trust	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement - Trust	Yes
2014: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan funding arrangement – Trust	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement - Trust	Yes
2013: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan funding arrangement – Trust	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement - Trust	Yes
2012: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
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)	No
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
2011: LAWRENCE COUNTY MEMORIAL HOSPITAL RETIREMENT PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	First time form 5500 has been submitted	Yes
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-826951

Policy instance

Insurance contract or identification number	GA-826951
Number of Individuals Covered	0
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $9,557
Total amount of fees paid to insurance company	USD $1,817
Are there contracts with allocated funds for individual policies?	0
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
Commission paid to Insurance Broker	USD $9,557
Insurance broker organization code?	4
Amount paid for insurance broker fees	1817
Additional information about fees paid to insurance broker	ADMINISTRATION

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-826951

Policy instance

Insurance contract or identification number	GA-826951
Number of Individuals Covered	133
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $8,041
Total amount of fees paid to insurance company	USD $1,523
Are there contracts with allocated funds for individual policies?	0
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
Amount paid for insurance broker fees	1523
Additional information about fees paid to insurance broker	ADMINISTRATION
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $8,041

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-826951

Policy instance

Insurance contract or identification number	GA-826951
Number of Individuals Covered	122
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $7,354
Total amount of fees paid to insurance company	USD $1,398
Are there contracts with allocated funds for individual policies?	0
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
Commission paid to Insurance Broker	USD $7,354
Insurance broker organization code?	4
Amount paid for insurance broker fees	1398
Additional information about fees paid to insurance broker	ADMINISTRATION

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-826951

Policy instance

Insurance contract or identification number	GA-826951
Number of Individuals Covered	119
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $6,727
Total amount of fees paid to insurance company	USD $1,279
Are there contracts with allocated funds for individual policies?	0
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

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-826951

Policy instance

Insurance contract or identification number	GA-826951
Number of Individuals Covered	122
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $4,608
Total amount of fees paid to insurance company	USD $768
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
Commission paid to Insurance Broker	USD $4,608
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	LOREN D. STARK COMPANY

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-826951

Policy instance

Insurance contract or identification number	GA-826951
Number of Individuals Covered	125
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $3,938
Total amount of fees paid to insurance company	USD $656
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
Commission paid to Insurance Broker	USD $3,938
Insurance broker organization code?	3
Amount paid for insurance broker fees	656
Additional information about fees paid to insurance broker	ADMINISTRATION
Insurance broker name	LOREN D. STARK COMPANY

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-826951

Policy instance

Insurance contract or identification number	GA-826951
Number of Individuals Covered	120
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $2,812
Total amount of fees paid to insurance company	USD $469
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
Commission paid to Insurance Broker	USD $2,812
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	LOREN D. STARK COMPANY

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-826951

Policy instance

Insurance contract or identification number	GA-826951
Number of Individuals Covered	115
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $1,392
Total amount of fees paid to insurance company	USD $286
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
Commission paid to Insurance Broker	USD $1,392
Insurance broker organization code?	3
Amount paid for insurance broker fees	286
Additional information about fees paid to insurance broker	ADMINISTRATION
Insurance broker name	LOREN D. STARK COMPANY

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA826951

Policy instance

Insurance contract or identification number	GA826951
Number of Individuals Covered	149
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $4,763
Total amount of fees paid to insurance company	USD $411
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
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

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Company Name:	LAWRENCE COUNTY MEMORIAL HOSPITAL
Employer identification number (EIN):	800618988
NAIC Classification:	622000
NAIC Description:	Hospitals