401k Plan data: BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN plan

BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 401k Plan overview

Plan Name	BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN
Plan identification number	001

BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Money purchase (other than target benefit)
Profit-sharing
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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

BARNES-KASSON COUNTY HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: BARNES-KASSON COUNTY HOSPITAL

Employer identification number (EIN): 240798681

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 SARA F ADORNATO
001 2013-01-01 SARA ADORNATO
001 2012-01-01 SARA ADORNATO SARA ADORNATO 2013-09-02
001 2011-01-01 SARA ADORNATO

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2014-01-01	SARA F ADORNATO
001	2013-01-01	SARA ADORNATO
001	2012-01-01	SARA ADORNATO	SARA ADORNATO	2013-09-02
001	2011-01-01	SARA ADORNATO

Plan Statistics for BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN

401k plan membership statisitcs for BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN

Measure Date Value
2014: BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 189
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 0
Number of participants with account balances 2014-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 201
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 143
Number of retired or separated participants receiving benefits 2013-01-01 1
Number of other retired or separated participants entitled to future benefits 2013-01-01 42
Total of all active and inactive participants 2013-01-01 186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 3
Total participants 2013-01-01 189
Number of participants with account balances 2013-01-01 181
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 208
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 152
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 49
Total of all active and inactive participants 2012-01-01 201
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 3
Total participants 2012-01-01 204
Number of participants with account balances 2012-01-01 197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 1
2011: BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 228
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 167
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 42
Total of all active and inactive participants 2011-01-01 209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 3
Total participants 2011-01-01 212
Number of participants with account balances 2011-01-01 204
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2014: BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	189
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	0
Number of participants with account balances	2014-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	201
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	143
Number of retired or separated participants receiving benefits	2013-01-01	1
Number of other retired or separated participants entitled to future benefits	2013-01-01	42
Total of all active and inactive participants	2013-01-01	186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	3
Total participants	2013-01-01	189
Number of participants with account balances	2013-01-01	181
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	208
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	152
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	49
Total of all active and inactive participants	2012-01-01	201
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	3
Total participants	2012-01-01	204
Number of participants with account balances	2012-01-01	197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	1
2011: BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	228
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	167
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	42
Total of all active and inactive participants	2011-01-01	209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	3
Total participants	2011-01-01	212
Number of participants with account balances	2011-01-01	204
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN

Measure	Date	Value
2014 : BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-09-30	$0
Total income from all sources (including contributions)	2014-09-30	$82,181
Total loss/gain on sale of assets	2014-09-30	$0
Total of all expenses incurred	2014-09-30	$2,522,336
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-09-30	$2,521,186
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-09-30	$0
Value of total assets at end of year	2014-09-30	$0
Value of total assets at beginning of year	2014-09-30	$2,440,155
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-09-30	$1,150
Total interest from all sources	2014-09-30	$7,586
Total dividends received (eg from common stock, registered investment company shares)	2014-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-09-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2014-09-30	$0
Was this plan covered by a fidelity bond	2014-09-30	Yes
Value of fidelity bond cover	2014-09-30	$300,000
If this is an individual account plan, was there a blackout period	2014-09-30	No
Funding deficiency by the employer to the plan for this plan year	2014-09-30	$0
Minimum employer required contribution for this plan year	2014-09-30	$0
Amount contributed by the employer to the plan for this plan year	2014-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2014-09-30	No
Participant contributions at end of year	2014-09-30	$0
Participant contributions at beginning of year	2014-09-30	$49,334
Administrative expenses (other) incurred	2014-09-30	$1,150
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-09-30	No
Value of net income/loss	2014-09-30	$-2,440,155
Value of net assets at end of year (total assets less liabilities)	2014-09-30	$0
Value of net assets at beginning of year (total assets less liabilities)	2014-09-30	$2,440,155
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-09-30	No
Were any leases to which the plan was party in default or uncollectible	2014-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-09-30	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-09-30	$1,862,326
Interest on participant loans	2014-09-30	$1,009
Interest earned on other investments	2014-09-30	$6,577
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-09-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-09-30	$528,495
Net investment gain/loss from pooled separate accounts	2014-09-30	$74,595
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-09-30	No
Was there a failure to transmit to the plan any participant contributions	2014-09-30	No
Has the plan failed to provide any benefit when due under the plan	2014-09-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-09-30	$2,521,186
Did the plan have assets held for investment	2014-09-30	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	2014-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-09-30	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2014-09-30	Disclaimer
Accountancy firm name	2014-09-30	ARNETT CARBIS TOOTHMAN LLP
Accountancy firm EIN	2014-09-30	550486667
2013 : BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$260,358
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$199,794
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$194,726
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$0
Value of total assets at end of year	2013-12-31	$2,440,155
Value of total assets at beginning of year	2013-12-31	$2,379,591
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$5,068
Total interest from all sources	2013-12-31	$17,091
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$300,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Participant contributions at end of year	2013-12-31	$49,334
Participant contributions at beginning of year	2013-12-31	$52,055
Administrative expenses (other) incurred	2013-12-31	$5,068
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$60,564
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,440,155
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,379,591
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$1,862,326
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,783,398
Interest on participant loans	2013-12-31	$2,128
Interest earned on other investments	2013-12-31	$14,963
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$528,495
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$544,138
Net investment gain/loss from pooled separate accounts	2013-12-31	$243,267
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$194,726
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	CARBIS WALKER, LLP
Accountancy firm EIN	2013-12-31	250988255
2012 : BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Expenses. Interest paid	2012-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$193,740
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$85,064
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$74,345
Expenses. Certain deemed distributions of participant loans	2012-12-31	$5,264
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$0
Value of total assets at end of year	2012-12-31	$2,379,591
Value of total assets at beginning of year	2012-12-31	$2,270,915
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$5,455
Total interest from all sources	2012-12-31	$17,846
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$300,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$0
Participant contributions at end of year	2012-12-31	$52,055
Participant contributions at beginning of year	2012-12-31	$54,995
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$5,455
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$108,676
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,379,591
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$2,270,915
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$1,783,398
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$1,727,065
Interest on participant loans	2012-12-31	$2,679
Interest earned on other investments	2012-12-31	$15,167
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$544,138
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$488,855
Net investment gain/loss from pooled separate accounts	2012-12-31	$175,894
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$74,345
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	CARBIS WALKER LLP
Accountancy firm EIN	2012-12-31	250988255
2011 : BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$-60,803
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$105,347
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$99,950
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$0
Value of total assets at end of year	2011-12-31	$2,270,915
Value of total assets at beginning of year	2011-12-31	$2,437,065
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$5,397
Total interest from all sources	2011-12-31	$17,390
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$300,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$0
Participant contributions at end of year	2011-12-31	$54,995
Participant contributions at beginning of year	2011-12-31	$42,563
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$0
Administrative expenses (other) incurred	2011-12-31	$5,397
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-166,150
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$2,270,915
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$2,437,065
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$1,727,065
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$1,854,797
Interest on participant loans	2011-12-31	$2,391
Interest earned on other investments	2011-12-31	$14,999
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$488,855
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$539,705
Net investment gain/loss from pooled separate accounts	2011-12-31	$-78,193
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$99,950
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	CARBIS WALKER, LLP
Accountancy firm EIN	2011-12-31	250988255
2010 : BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets from this plan	2010-12-31	$151,603
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$251,427
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$177,935
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$171,905
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$23,167
Value of total assets at end of year	2010-12-31	$2,437,065
Value of total assets at beginning of year	2010-12-31	$2,515,176
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$6,030
Total interest from all sources	2010-12-31	$20,052
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$250,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Participant contributions at end of year	2010-12-31	$42,563
Participant contributions at beginning of year	2010-12-31	$23,384
Administrative expenses (other) incurred	2010-12-31	$6,030
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$73,492
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$2,437,065
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,515,176
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$1,854,797
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$1,830,622
Interest on participant loans	2010-12-31	$2,115
Interest earned on other investments	2010-12-31	$17,937
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$539,705
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$661,170
Net investment gain/loss from pooled separate accounts	2010-12-31	$208,208
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$23,167
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$171,905
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	CARBIS WALKER LLP
Accountancy firm EIN	2010-12-31	250988255

Form 5500 Responses for BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN

2014: BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	Yes
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: BARNES-KASSON COUNTY HOSPITAL RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	BARNES-KASSON COUNTY HOSPITAL
Employer identification number (EIN):	240798681
NAIC Classification:	622000
NAIC Description:	Hospitals