401k Plan data: AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN plan

AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 401k Plan overview

Plan Name	AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN
Plan identification number	002

AULTMAN ORRVILLE HOSPITAL 403(B) 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.
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

ORRVILLE HOSPITAL FOUNDATION has sponsored the creation of one or more 401k plans.

Company Name: ORRVILLE HOSPITAL FOUNDATION

Employer identification number (EIN): 340733138

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2014-01-01 MATTHEW STEWART
002 2013-01-01 MATTHEW STEWART
002 2012-01-01 MATTHEW STEWART
002 2011-01-01 ADAM LUNTZ
002 2009-01-01 STEVE KNOX

Plan id#	Filing Submission Date	Name of Administrator
002	2014-01-01	MATTHEW STEWART
002	2013-01-01	MATTHEW STEWART
002	2012-01-01	MATTHEW STEWART
002	2011-01-01	ADAM LUNTZ
002	2009-01-01	STEVE KNOX

Plan Statistics for AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN

401k plan membership statisitcs for AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN

Measure Date Value
2014: AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 183
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: AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 241
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 182
Total of all active and inactive participants 2013-01-01 182
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 183
Number of participants with account balances 2013-01-01 183
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 59
2012: AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 253
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 221
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 20
Total of all active and inactive participants 2012-01-01 241
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 241
Number of participants with account balances 2012-01-01 206
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 7
2011: AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 238
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 237
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 16
Total of all active and inactive participants 2011-01-01 253
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 253
Number of participants with account balances 2011-01-01 210
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 17
2009: AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 244
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 252
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 11
Total of all active and inactive participants 2009-01-01 263
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 263
Number of participants with account balances 2009-01-01 176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 5

Measure	Date	Value
2014: AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	183
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: AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	241
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	182
Total of all active and inactive participants	2013-01-01	182
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	183
Number of participants with account balances	2013-01-01	183
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	59
2012: AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	253
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	221
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	20
Total of all active and inactive participants	2012-01-01	241
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	241
Number of participants with account balances	2012-01-01	206
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	7
2011: AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	238
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	237
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	16
Total of all active and inactive participants	2011-01-01	253
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	253
Number of participants with account balances	2011-01-01	210
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	17
2009: AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	244
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	252
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	11
Total of all active and inactive participants	2009-01-01	263
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	263
Number of participants with account balances	2009-01-01	176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	5

Financial Data on AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN

Measure	Date	Value
2014 : AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-10-15	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-10-15	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-10-15	$0
Total income from all sources (including contributions)	2014-10-15	$55,779
Total loss/gain on sale of assets	2014-10-15	$0
Total of all expenses incurred	2014-10-15	$4,519,985
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-10-15	$4,471,298
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-10-15	$0
Value of total assets at end of year	2014-10-15	$0
Value of total assets at beginning of year	2014-10-15	$4,464,206
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-10-15	$48,687
Total interest from all sources	2014-10-15	$35
Total dividends received (eg from common stock, registered investment company shares)	2014-10-15	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-10-15	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2014-10-15	$0
Administrative expenses professional fees incurred	2014-10-15	$13,650
Was this plan covered by a fidelity bond	2014-10-15	Yes
Value of fidelity bond cover	2014-10-15	$1,000,000
If this is an individual account plan, was there a blackout period	2014-10-15	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-10-15	$0
Were there any nonexempt tranactions with any party-in-interest	2014-10-15	No
Contributions received from participants	2014-10-15	$0
Participant contributions at beginning of year	2014-10-15	$27,787
Income. Received or receivable in cash from other sources (including rollovers)	2014-10-15	$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	2014-10-15	No
Income. Non cash contributions	2014-10-15	$0
Value of net income/loss	2014-10-15	$-4,464,206
Value of net assets at end of year (total assets less liabilities)	2014-10-15	$0
Value of net assets at beginning of year (total assets less liabilities)	2014-10-15	$4,464,206
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-10-15	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-10-15	No
Were any leases to which the plan was party in default or uncollectible	2014-10-15	No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-10-15	$4,244,654
Interest on participant loans	2014-10-15	$30
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-10-15	$191,765
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-10-15	$191,765
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-10-15	$5
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-10-15	$55,744
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-10-15	No
Was there a failure to transmit to the plan any participant contributions	2014-10-15	Yes
Has the plan failed to provide any benefit when due under the plan	2014-10-15	No
Contributions received in cash from employer	2014-10-15	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-10-15	$4,471,298
Contract administrator fees	2014-10-15	$35,037
Did the plan have assets held for investment	2014-10-15	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	2014-10-15	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-10-15	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-10-15	Yes
Opinion of an independent qualified public accountant for this plan	2014-10-15	Disclaimer
Accountancy firm name	2014-10-15	BRUNER COX,LLC
Accountancy firm EIN	2014-10-15	340641962
2013 : AULTMAN ORRVILLE HOSPITAL 403(B) 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	$7,856
Total income from all sources (including contributions)	2013-12-31	$877,727
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$730,139
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$694,188
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$49,395
Value of total assets at end of year	2013-12-31	$4,464,206
Value of total assets at beginning of year	2013-12-31	$4,324,474
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$35,951
Total interest from all sources	2013-12-31	$3,174
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	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$0
Participant contributions at end of year	2013-12-31	$27,787
Participant contributions at beginning of year	2013-12-31	$80,639
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$16,741
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$49,395
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$5,110
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$7,856
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	2013-12-31	$2,745
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
Income. Non cash contributions	2013-12-31	$0
Value of net income/loss	2013-12-31	$147,588
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$4,464,206
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$4,316,618
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	$4,244,654
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$4,065,481
Interest on participant loans	2013-12-31	$3,133
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$191,765
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$147,822
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$147,822
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$41
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$825,158
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	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$0
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$5,936
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$694,188
Contract administrator fees	2013-12-31	$35,951
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	BRUNER COX,LLC
Accountancy firm EIN	2013-12-31	340641962
2012 : AULTMAN ORRVILLE HOSPITAL 403(B) 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	$7,856
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$2,286
Total income from all sources (including contributions)	2012-12-31	$1,282,361
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$190,428
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$161,103
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$837,537
Value of total assets at end of year	2012-12-31	$4,324,474
Value of total assets at beginning of year	2012-12-31	$3,226,971
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$29,325
Total interest from all sources	2012-12-31	$2,798
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$105,499
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$105,499
Administrative expenses professional fees incurred	2012-12-31	$29,325
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$476,477
Participant contributions at end of year	2012-12-31	$80,639
Participant contributions at beginning of year	2012-12-31	$39,017
Participant contributions at end of year	2012-12-31	$16,741
Participant contributions at beginning of year	2012-12-31	$16,205
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$199,682
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$5,110
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$7,856
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$2,286
Total non interest bearing cash at end of year	2012-12-31	$2,745
Total non interest bearing cash at beginning of year	2012-12-31	$2,016
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	$1,091,933
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$4,316,618
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$3,224,685
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	$4,065,481
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$3,039,018
Interest on participant loans	2012-12-31	$2,631
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$147,822
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$125,807
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$125,807
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$167
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$336,527
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	$161,378
Employer contributions (assets) at end of year	2012-12-31	$5,936
Employer contributions (assets) at beginning of year	2012-12-31	$4,908
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$161,103
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	PLANTE MORAN
Accountancy firm EIN	2012-12-31	381357951
2011 : AULTMAN ORRVILLE HOSPITAL 403(B) 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	$2,286
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$24,972
Total income from all sources (including contributions)	2011-12-31	$532,945
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$381,661
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$354,679
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$644,441
Value of total assets at end of year	2011-12-31	$3,226,971
Value of total assets at beginning of year	2011-12-31	$3,098,373
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$26,982
Total interest from all sources	2011-12-31	$1,094
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$75,095
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$75,095
Administrative expenses professional fees incurred	2011-12-31	$26,982
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$474,377
Participant contributions at end of year	2011-12-31	$39,017
Participant contributions at beginning of year	2011-12-31	$4,993
Participant contributions at end of year	2011-12-31	$16,205
Participant contributions at beginning of year	2011-12-31	$17,443
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$10,797
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$2,286
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$24,972
Total non interest bearing cash at end of year	2011-12-31	$2,016
Total non interest bearing cash at beginning of year	2011-12-31	$1,668
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	$151,284
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$3,224,685
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$3,073,401
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	$3,039,018
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$2,801,379
Interest on participant loans	2011-12-31	$993
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$125,807
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$110,564
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$110,564
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$101
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-187,685
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	Yes
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	$159,267
Employer contributions (assets) at end of year	2011-12-31	$4,908
Employer contributions (assets) at beginning of year	2011-12-31	$162,326
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$354,679
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
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	PLANTE AND MORAN, PLLC
Accountancy firm EIN	2011-12-31	381357951
2010 : AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$24,972
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$1,100
Total income from all sources (including contributions)	2010-12-31	$1,248,760
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$131,238
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$113,280
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$903,268
Value of total assets at end of year	2010-12-31	$3,098,373
Value of total assets at beginning of year	2010-12-31	$1,956,979
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$17,958
Total interest from all sources	2010-12-31	$129
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$61,662
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$61,662
Administrative expenses professional fees incurred	2010-12-31	$17,958
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$537,341
Participant contributions at end of year	2010-12-31	$4,993
Participant contributions at beginning of year	2010-12-31	$0
Participant contributions at end of year	2010-12-31	$17,443
Participant contributions at beginning of year	2010-12-31	$16,939
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$43,215
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$24,972
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$1,100
Total non interest bearing cash at end of year	2010-12-31	$1,668
Total non interest bearing cash at beginning of year	2010-12-31	$3,976
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	$1,117,522
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$3,073,401
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$1,955,879
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	$2,801,379
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$1,602,253
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$110,564
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$75,760
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$75,760
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$129
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$283,701
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	Yes
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	$322,712
Employer contributions (assets) at end of year	2010-12-31	$162,326
Employer contributions (assets) at beginning of year	2010-12-31	$258,051
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$113,280
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
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	PLANTE MORAN
Accountancy firm EIN	2010-12-31	381357951
2009 : AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN

2014: AULTMAN ORRVILLE HOSPITAL 403(B) 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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: AULTMAN ORRVILLE HOSPITAL 403(B) 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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: AULTMAN ORRVILLE HOSPITAL 403(B) 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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: AULTMAN ORRVILLE HOSPITAL 403(B) 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: AULTMAN ORRVILLE HOSPITAL 403(B) RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	ORRVILLE HOSPITAL FOUNDATION
Employer identification number (EIN):	340733138
NAIC Classification:	622000
NAIC Description:	Hospitals