401k Plan data: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) plan

MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 401k Plan overview

Plan Name	MEMORIAL HOSPITAL RETIREMENT PLAN 401(A)
Plan identification number	009

MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

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

Company Name: MEMORIAL HOSPITAL

Employer identification number (EIN): 344430849

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEMORIAL HOSPITAL RETIREMENT PLAN 401(A)

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
009 2016-01-01 KAREN STRAUSS
009 2015-01-01 KAREN STRAUSS KAREN STRAUSS 2016-10-17
009 2014-01-01 DAVID BREWER DAVID BREWER 2015-10-14
009 2013-01-01 DAVID BREWER
009 2012-01-01 DAVID BREWER
009 2011-01-01 RICK RUPPEL
009 2009-01-01 RICK RUPPEL

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
009	2016-01-01	KAREN STRAUSS
009	2015-01-01	KAREN STRAUSS	KAREN STRAUSS	2016-10-17
009	2014-01-01	DAVID BREWER	DAVID BREWER	2015-10-14
009	2013-01-01	DAVID BREWER
009	2012-01-01	DAVID BREWER
009	2011-01-01	RICK RUPPEL
009	2009-01-01	RICK RUPPEL

Plan Statistics for MEMORIAL HOSPITAL RETIREMENT PLAN 401(A)

401k plan membership statisitcs for MEMORIAL HOSPITAL RETIREMENT PLAN 401(A)

Measure Date Value
2016: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2016 401k membership
Total participants, beginning-of-year 2016-01-01 366
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2015 401k membership
Total participants, beginning-of-year 2015-01-01 408
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 305
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 61
Total of all active and inactive participants 2015-01-01 366
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 366
Number of participants with account balances 2015-01-01 292
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2014 401k membership
Total participants, beginning-of-year 2014-01-01 446
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 385
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 30
Total of all active and inactive participants 2014-01-01 415
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 415
Number of participants with account balances 2014-01-01 329
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2013 401k membership
Total participants, beginning-of-year 2013-01-01 471
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 406
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 37
Total of all active and inactive participants 2013-01-01 443
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 443
Number of participants with account balances 2013-01-01 354
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 11
2012: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2012 401k membership
Total participants, beginning-of-year 2012-01-01 521
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 444
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 29
Total of all active and inactive participants 2012-01-01 473
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 473
Number of participants with account balances 2012-01-01 388
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 18
2011: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2011 401k membership
Total participants, beginning-of-year 2011-01-01 581
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 492
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 29
Total of all active and inactive participants 2011-01-01 521
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 521
Number of participants with account balances 2011-01-01 447
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 16
2009: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2009 401k membership
Total participants, beginning-of-year 2009-01-01 658
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 610
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 104
Total of all active and inactive participants 2009-01-01 714
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 714
Number of participants with account balances 2009-01-01 527
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 8

Measure	Date	Value
2016: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2016 401k membership
Total participants, beginning-of-year	2016-01-01	366
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2015 401k membership
Total participants, beginning-of-year	2015-01-01	408
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	305
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	61
Total of all active and inactive participants	2015-01-01	366
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	366
Number of participants with account balances	2015-01-01	292
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2014 401k membership
Total participants, beginning-of-year	2014-01-01	446
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	385
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	30
Total of all active and inactive participants	2014-01-01	415
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	415
Number of participants with account balances	2014-01-01	329
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2013 401k membership
Total participants, beginning-of-year	2013-01-01	471
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	406
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	37
Total of all active and inactive participants	2013-01-01	443
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	443
Number of participants with account balances	2013-01-01	354
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	11
2012: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2012 401k membership
Total participants, beginning-of-year	2012-01-01	521
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	444
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	29
Total of all active and inactive participants	2012-01-01	473
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	473
Number of participants with account balances	2012-01-01	388
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	18
2011: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2011 401k membership
Total participants, beginning-of-year	2011-01-01	581
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	492
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	29
Total of all active and inactive participants	2011-01-01	521
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	521
Number of participants with account balances	2011-01-01	447
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	16
2009: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2009 401k membership
Total participants, beginning-of-year	2009-01-01	658
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	610
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	104
Total of all active and inactive participants	2009-01-01	714
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	714
Number of participants with account balances	2009-01-01	527
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	8

Financial Data on MEMORIAL HOSPITAL RETIREMENT PLAN 401(A)

Measure	Date	Value
2016 : MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-04-29	$0
Total transfer of assets from this plan	2016-04-29	$2,602,652
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-04-29	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-04-29	$0
Total income from all sources (including contributions)	2016-04-29	$996,804
Total loss/gain on sale of assets	2016-04-29	$0
Total of all expenses incurred	2016-04-29	$1,337,071
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-04-29	$1,331,888
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-04-29	$981,571
Value of total assets at end of year	2016-04-29	$0
Value of total assets at beginning of year	2016-04-29	$2,942,919
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-04-29	$5,183
Total interest from all sources	2016-04-29	$5,449
Total dividends received (eg from common stock, registered investment company shares)	2016-04-29	$1,931
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-04-29	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-04-29	$1,931
Was this plan covered by a fidelity bond	2016-04-29	Yes
Value of fidelity bond cover	2016-04-29	$1,000,000
If this is an individual account plan, was there a blackout period	2016-04-29	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-04-29	$0
Were there any nonexempt tranactions with any party-in-interest	2016-04-29	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-04-29	No
Value of net income/loss	2016-04-29	$-340,267
Value of net assets at end of year (total assets less liabilities)	2016-04-29	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-04-29	$2,942,919
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-04-29	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-04-29	No
Were any leases to which the plan was party in default or uncollectible	2016-04-29	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-04-29	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-04-29	$2,150,559
Interest earned on other investments	2016-04-29	$5,449
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-04-29	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-04-29	$792,360
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-04-29	$7,853
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-04-29	No
Was there a failure to transmit to the plan any participant contributions	2016-04-29	No
Has the plan failed to provide any benefit when due under the plan	2016-04-29	No
Contributions received in cash from employer	2016-04-29	$981,571
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-04-29	$1,331,888
Contract administrator fees	2016-04-29	$5,183
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	2016-04-29	Yes
Did the plan have assets held for investment	2016-04-29	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	2016-04-29	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-04-29	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-04-29	Yes
Opinion of an independent qualified public accountant for this plan	2016-04-29	Disclaimer
Accountancy firm name	2016-04-29	PLANTE & MORAN, PLLC
Accountancy firm EIN	2016-04-29	381357951
2015 : MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$10,808
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$449,936
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$438,398
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$0
Value of total assets at end of year	2015-12-31	$2,942,919
Value of total assets at beginning of year	2015-12-31	$3,382,047
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$11,538
Total interest from all sources	2015-12-31	$15,541
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$15,495
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$15,495
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-439,128
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,942,919
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$3,382,047
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$2,150,559
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,513,928
Interest earned on other investments	2015-12-31	$15,541
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$792,360
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$868,119
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-20,228
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$438,398
Contract administrator fees	2015-12-31	$11,538
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2015-12-31	381357951
2014 : MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$184,292
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$202,304
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$190,638
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$0
Value of total assets at end of year	2014-12-31	$3,382,047
Value of total assets at beginning of year	2014-12-31	$3,400,059
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$11,666
Total interest from all sources	2014-12-31	$17,389
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$19,168
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$19,168
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-18,012
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$3,382,047
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$3,400,059
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$2,513,928
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$2,512,939
Interest earned on other investments	2014-12-31	$17,389
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$868,119
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$887,120
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$147,735
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$190,638
Contract administrator fees	2014-12-31	$11,666
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2014-12-31	381357951
2013 : MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 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	$583,543
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$307,028
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$296,183
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	$3,400,059
Value of total assets at beginning of year	2013-12-31	$3,123,544
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$10,845
Total interest from all sources	2013-12-31	$21,090
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$14,931
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$14,931
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
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
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	$276,515
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$3,400,059
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$3,123,544
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	$2,512,939
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$2,146,665
Interest earned on other investments	2013-12-31	$21,090
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$887,120
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$976,879
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$547,522
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	$296,183
Contract administrator fees	2013-12-31	$10,845
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	BLUE & CO., LLC
Accountancy firm EIN	2013-12-31	351178661
2012 : MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 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
Total income from all sources (including contributions)	2012-12-31	$338,784
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$332,891
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$323,372
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	$3,123,544
Value of total assets at beginning of year	2012-12-31	$3,117,651
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$9,519
Total interest from all sources	2012-12-31	$24,316
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$25,878
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	$25,878
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
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
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	$5,893
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$3,123,544
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$3,117,651
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	$2,146,665
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$2,056,314
Interest earned on other investments	2012-12-31	$24,316
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$976,879
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$1,061,337
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$288,590
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$323,372
Contract administrator fees	2012-12-31	$9,519
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	BLUE & CO., LLC
Accountancy firm EIN	2012-12-31	351178661
2011 : MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 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	$-5,350
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$413,315
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$402,726
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	$3,117,651
Value of total assets at beginning of year	2011-12-31	$3,536,316
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$10,589
Total interest from all sources	2011-12-31	$30,072
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$21,020
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$21,020
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
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	$-418,665
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$3,117,651
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$3,536,316
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	$2,056,314
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$2,283,136
Interest earned on other investments	2011-12-31	$30,072
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$1,061,337
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$1,253,180
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-56,442
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$402,726
Contract administrator fees	2011-12-31	$10,589
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	BLUE & CO., LLC
Accountancy firm EIN	2011-12-31	351178661
2010 : MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 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	$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	$399,899
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$350,141
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$339,282
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$54,766
Value of total assets at end of year	2010-12-31	$3,536,316
Value of total assets at beginning of year	2010-12-31	$3,486,558
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$10,859
Total interest from all sources	2010-12-31	$35,637
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$30,518
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	$30,518
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
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	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$54,766
Other income not declared elsewhere	2010-12-31	$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	2010-12-31	No
Value of net income/loss	2010-12-31	$49,758
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$3,536,316
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$3,486,558
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	$2,283,136
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$2,014,858
Interest earned on other investments	2010-12-31	$35,637
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$1,253,180
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$1,068,720
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$278,978
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	$0
Employer contributions (assets) at end of year	2010-12-31	$0
Employer contributions (assets) at beginning of year	2010-12-31	$402,980
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$339,282
Contract administrator fees	2010-12-31	$10,859
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	BLUE & CO. LLC
Accountancy firm EIN	2010-12-31	351178661

Form 5500 Responses for MEMORIAL HOSPITAL RETIREMENT PLAN 401(A)

2016: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 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	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
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
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 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
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 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
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: MEMORIAL HOSPITAL RETIREMENT PLAN 401(A) 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441462

Policy instance

Insurance contract or identification number	441462
Number of Individuals Covered	0
Insurance policy start date	2016-01-01
Insurance policy end date	2016-04-29
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $99
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?	Yes
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 $0
Amount paid for insurance broker fees	99
Additional information about fees paid to insurance broker	PRORATED INCENTIVE, NOT DEDUCTED FROM PLAN
Insurance broker organization code?	3
Insurance broker name	KESTRA INVESTMENT SERVICES LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441462

Policy instance

Insurance contract or identification number	441462
Number of Individuals Covered	366
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $362
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?	Yes
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 $0
Amount paid for insurance broker fees	362
Additional information about fees paid to insurance broker	PRORATED INCENTIVE, NOT DEDUCTED FROM PLAN
Insurance broker organization code?	3
Insurance broker name	NFP ADVISOR SERVICES LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441462

Policy instance

Insurance contract or identification number	441462
Number of Individuals Covered	415
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $161
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?	Yes
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 $0
Amount paid for insurance broker fees	161
Additional information about fees paid to insurance broker	PRORATED INCENTIVE, NOT DEDUCTED FROM PLAN
Insurance broker organization code?	3
Insurance broker name	NFP ADVISOR SERVICES LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441462

Policy instance

Insurance contract or identification number	441462
Number of Individuals Covered	443
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,640
Total amount of fees paid to insurance company	USD $4,174
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?	Yes
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 $2,292
Amount paid for insurance broker fees	3073
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	NFP SECURITIES INC.

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441462

Policy instance

Insurance contract or identification number	441462
Number of Individuals Covered	473
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,836
Total amount of fees paid to insurance company	USD $1,113
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?	Yes
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 $4,836
Amount paid for insurance broker fees	1113
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	G & W EQUITY SALES INC.

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441462

Policy instance

Insurance contract or identification number	441462
Number of Individuals Covered	521
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,837
Total amount of fees paid to insurance company	USD $4,510
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?	Yes
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

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441462

Policy instance

Insurance contract or identification number	441462
Number of Individuals Covered	581
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,010
Total amount of fees paid to insurance company	USD $4,306
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?	Yes
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

Potentially related plans

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Company Name:	MEMORIAL HOSPITAL
Employer identification number (EIN):	344430849
NAIC Classification:	622000
NAIC Description:	Hospitals