401k Plan data: WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN plan

WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN 401k Plan overview

Plan Name	WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN
Plan identification number	002

WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

WILLAMETTE FALLS HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: WILLAMETTE FALLS HOSPITAL

Employer identification number (EIN): 930426018

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2010-01-01 REBECCA BROWN
002 2009-01-01 REBECCA BROWN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2010-01-01	REBECCA BROWN
002	2009-01-01	REBECCA BROWN

Plan Statistics for WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN

401k plan membership statisitcs for WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN

Measure Date Value
2010: WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 915
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 0
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 0
Number of participants with account balances 2010-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 890
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 843
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 122
Total of all active and inactive participants 2009-01-01 965
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 965
Number of participants with account balances 2009-01-01 743
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 40

Measure	Date	Value
2010: WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	915
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	0
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	0
Number of participants with account balances	2010-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	890
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	843
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	122
Total of all active and inactive participants	2009-01-01	965
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	965
Number of participants with account balances	2009-01-01	743
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	40

Financial Data on WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN

Measure	Date	Value
2010 : WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN 2010 401k financial data
Unrealized appreciation/depreciation of real estate assets	2010-03-15	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2010-03-15	$0
Total unrealized appreciation/depreciation of assets	2010-03-15	$0
Total transfer of assets to this plan	2010-03-15	$0
Total transfer of assets from this plan	2010-03-15	$37,784,595
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-03-15	$0
Total income from all sources (including contributions)	2010-03-15	$872,564
Total loss/gain on sale of assets	2010-03-15	$0
Total of all expenses incurred	2010-03-15	$466,162
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-03-15	$454,252
Expenses. Certain deemed distributions of participant loans	2010-03-15	$0
Value of total corrective distributions	2010-03-15	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-03-15	$1,261
Value of total assets at end of year	2010-03-15	$0
Value of total assets at beginning of year	2010-03-15	$37,378,193
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-03-15	$11,910
Total income from rents	2010-03-15	$0
Total interest from all sources	2010-03-15	$7,640
Total dividends received (eg from common stock, registered investment company shares)	2010-03-15	$3,935
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-03-15	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-03-15	$3,935
Administrative expenses professional fees incurred	2010-03-15	$0
Was this plan covered by a fidelity bond	2010-03-15	No
If this is an individual account plan, was there a blackout period	2010-03-15	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-03-15	$0
Were there any nonexempt tranactions with any party-in-interest	2010-03-15	No
Contributions received from participants	2010-03-15	$0
Participant contributions at end of year	2010-03-15	$0
Participant contributions at beginning of year	2010-03-15	$716,165
Participant contributions at end of year	2010-03-15	$0
Participant contributions at beginning of year	2010-03-15	$796
Income. Received or receivable in cash from other sources (including rollovers)	2010-03-15	$1,261
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-03-15	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-03-15	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-03-15	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-03-15	$0
Other income not declared elsewhere	2010-03-15	$0
Administrative expenses (other) incurred	2010-03-15	$0
Liabilities. Value of operating payables at beginning of year	2010-03-15	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-03-15	No
Value of net income/loss	2010-03-15	$406,402
Value of net assets at end of year (total assets less liabilities)	2010-03-15	$0
Value of net assets at beginning of year (total assets less liabilities)	2010-03-15	$37,378,193
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-03-15	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-03-15	No
Were any leases to which the plan was party in default or uncollectible	2010-03-15	No
Investment advisory and management fees	2010-03-15	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-03-15	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-03-15	$36,660,641
Interest on participant loans	2010-03-15	$7,640
Income. Interest from loans (other than to participants)	2010-03-15	$0
Interest earned on other investments	2010-03-15	$0
Income. Interest from US Government securities	2010-03-15	$0
Income. Interest from corporate debt instruments	2010-03-15	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-03-15	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2010-03-15	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-03-15	$859,728
Net investment gain/loss from pooled separate accounts	2010-03-15	$0
Net investment gain or loss from common/collective trusts	2010-03-15	$0
Net gain/loss from 103.12 investment entities	2010-03-15	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-03-15	No
Was there a failure to transmit to the plan any participant contributions	2010-03-15	No
Has the plan failed to provide any benefit when due under the plan	2010-03-15	No
Contributions received in cash from employer	2010-03-15	$0
Employer contributions (assets) at end of year	2010-03-15	$0
Employer contributions (assets) at beginning of year	2010-03-15	$591
Income. Dividends from preferred stock	2010-03-15	$0
Income. Dividends from common stock	2010-03-15	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-03-15	$454,252
Contract administrator fees	2010-03-15	$11,910
Liabilities. Value of benefit claims payable at beginning of year	2010-03-15	$0
Did the plan have assets held for investment	2010-03-15	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-03-15	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-03-15	Yes
Aggregate proceeds on sale of assets	2010-03-15	$0
Aggregate carrying amount (costs) on sale of assets	2010-03-15	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2010-03-15	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-03-15	No
Opinion of an independent qualified public accountant for this plan	2010-03-15	Disclaimer
Accountancy firm name	2010-03-15	KPMG LLP
Accountancy firm EIN	2010-03-15	135565207
2009 : WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY 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 WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN

2010: WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	Yes
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2010-01-01	Plan is a collectively bargained plan	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: WILLAMETTE FALLS HOSPITAL TAX SHELTERED ANNUITY 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	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	WILLAMETTE FALLS HOSPITAL
Employer identification number (EIN):	930426018
NAIC Classification:	622000
NAIC Description:	Hospitals