401k Plan data: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN plan

DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 401k Plan overview

Plan Name	DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN
Plan identification number	001

DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Money purchase (other than target benefit)
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.

401k Sponsoring company profile

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

Company Name: DEKALB MEMORIAL HOSPITAL, INC.

Employer identification number (EIN): 351064295

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-01-01
001 2019-01-01
001 2017-01-01 BRET CLAGHORN
001 2016-01-01 BRET CLAGHORN
001 2015-01-01 CRAIG POLKOW
001 2014-01-01 CRAIG POLKOW
001 2013-01-01 AMY CROUCH
001 2012-01-01 AMY CROUCH
001 2011-01-01 AMY CROUCH
001 2009-01-01 PAMELA CAVACINI PAMELA CAVACINI 2010-10-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2020-01-01
001	2019-01-01
001	2017-01-01	BRET CLAGHORN
001	2016-01-01	BRET CLAGHORN
001	2015-01-01	CRAIG POLKOW
001	2014-01-01	CRAIG POLKOW
001	2013-01-01	AMY CROUCH
001	2012-01-01	AMY CROUCH
001	2011-01-01	AMY CROUCH
001	2009-01-01	PAMELA CAVACINI	PAMELA CAVACINI	2010-10-15

Plan Statistics for DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN

401k plan membership statisitcs for DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN

Measure Date Value
2020: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 0
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 0
Number of participants with account balances 2020-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 417
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 72
Number of retired or separated participants receiving benefits 2019-01-01 6
Number of other retired or separated participants entitled to future benefits 2019-01-01 137
Total of all active and inactive participants 2019-01-01 215
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 1
Total participants 2019-01-01 216
Number of participants with account balances 2019-01-01 216
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2017: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 563
Number of retired or separated participants receiving benefits 2017-01-01 7
Number of other retired or separated participants entitled to future benefits 2017-01-01 130
Total of all active and inactive participants 2017-01-01 137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 1
Total participants 2017-01-01 138
Number of participants with account balances 2017-01-01 476
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 634
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 377
Number of retired or separated participants receiving benefits 2016-01-01 5
Number of other retired or separated participants entitled to future benefits 2016-01-01 180
Total of all active and inactive participants 2016-01-01 562
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 1
Total participants 2016-01-01 563
Number of participants with account balances 2016-01-01 563
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 615
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 429
Number of retired or separated participants receiving benefits 2015-01-01 6
Number of other retired or separated participants entitled to future benefits 2015-01-01 198
Total of all active and inactive participants 2015-01-01 633
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 1
Total participants 2015-01-01 634
Number of participants with account balances 2015-01-01 619
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 1
2014: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 606
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 395
Number of retired or separated participants receiving benefits 2014-01-01 9
Number of other retired or separated participants entitled to future benefits 2014-01-01 197
Total of all active and inactive participants 2014-01-01 601
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 1
Total participants 2014-01-01 602
Number of participants with account balances 2014-01-01 602
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 23
2013: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 543
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 424
Number of retired or separated participants receiving benefits 2013-01-01 4
Number of other retired or separated participants entitled to future benefits 2013-01-01 176
Total of all active and inactive participants 2013-01-01 604
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 2
Total participants 2013-01-01 606
Number of participants with account balances 2013-01-01 606
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 25
2012: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 501
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 418
Number of retired or separated participants receiving benefits 2012-01-01 4
Number of other retired or separated participants entitled to future benefits 2012-01-01 127
Total of all active and inactive participants 2012-01-01 549
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 2
Total participants 2012-01-01 551
Number of participants with account balances 2012-01-01 543
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 18
2011: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 511
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 389
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 101
Total of all active and inactive participants 2011-01-01 492
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 493
Number of participants with account balances 2011-01-01 501
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 9
2009: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 485
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 364
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 116
Total of all active and inactive participants 2009-01-01 481
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 482
Number of participants with account balances 2009-01-01 482
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 4

Measure	Date	Value
2020: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	0
Number of participants with account balances	2020-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	417
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	72
Number of retired or separated participants receiving benefits	2019-01-01	6
Number of other retired or separated participants entitled to future benefits	2019-01-01	137
Total of all active and inactive participants	2019-01-01	215
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	1
Total participants	2019-01-01	216
Number of participants with account balances	2019-01-01	216
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2017: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	563
Number of retired or separated participants receiving benefits	2017-01-01	7
Number of other retired or separated participants entitled to future benefits	2017-01-01	130
Total of all active and inactive participants	2017-01-01	137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	1
Total participants	2017-01-01	138
Number of participants with account balances	2017-01-01	476
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	634
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	377
Number of retired or separated participants receiving benefits	2016-01-01	5
Number of other retired or separated participants entitled to future benefits	2016-01-01	180
Total of all active and inactive participants	2016-01-01	562
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	1
Total participants	2016-01-01	563
Number of participants with account balances	2016-01-01	563
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	615
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	429
Number of retired or separated participants receiving benefits	2015-01-01	6
Number of other retired or separated participants entitled to future benefits	2015-01-01	198
Total of all active and inactive participants	2015-01-01	633
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	1
Total participants	2015-01-01	634
Number of participants with account balances	2015-01-01	619
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	1
2014: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	606
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	395
Number of retired or separated participants receiving benefits	2014-01-01	9
Number of other retired or separated participants entitled to future benefits	2014-01-01	197
Total of all active and inactive participants	2014-01-01	601
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	1
Total participants	2014-01-01	602
Number of participants with account balances	2014-01-01	602
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	23
2013: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	543
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	424
Number of retired or separated participants receiving benefits	2013-01-01	4
Number of other retired or separated participants entitled to future benefits	2013-01-01	176
Total of all active and inactive participants	2013-01-01	604
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	2
Total participants	2013-01-01	606
Number of participants with account balances	2013-01-01	606
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	25
2012: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	501
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	418
Number of retired or separated participants receiving benefits	2012-01-01	4
Number of other retired or separated participants entitled to future benefits	2012-01-01	127
Total of all active and inactive participants	2012-01-01	549
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	2
Total participants	2012-01-01	551
Number of participants with account balances	2012-01-01	543
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	18
2011: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	511
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	389
Number of retired or separated participants receiving benefits	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	101
Total of all active and inactive participants	2011-01-01	492
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	493
Number of participants with account balances	2011-01-01	501
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	9
2009: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	485
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	364
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	116
Total of all active and inactive participants	2009-01-01	481
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	482
Number of participants with account balances	2009-01-01	482
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	4

Financial Data on DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN

Measure	Date	Value
2020 : DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$-314,261
Total of all expenses incurred	2020-12-31	$6,852,691
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$6,841,069
Value of total assets at end of year	2020-12-31	$0
Value of total assets at beginning of year	2020-12-31	$7,166,952
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$11,622
Total interest from all sources	2020-12-31	$13,445
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$8,237
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2020-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$8,237
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Administrative expenses (other) incurred	2020-12-31	$9,106
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$-7,166,952
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$7,166,952
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$2,516
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$5,661,155
Interest earned on other investments	2020-12-31	$13,445
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$1,505,797
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$-335,943
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$6,841,069
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	2020-12-31	No
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	BLUE & CO., LLC
Accountancy firm EIN	2020-12-31	351178661
2019 : DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$2,766,731
Total of all expenses incurred	2019-12-31	$11,088,601
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$10,987,312
Value of total assets at end of year	2019-12-31	$7,166,952
Value of total assets at beginning of year	2019-12-31	$15,488,822
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$101,289
Total interest from all sources	2019-12-31	$54,646
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$162,524
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2019-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$162,524
Administrative expenses professional fees incurred	2019-12-31	$58,667
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Administrative expenses (other) incurred	2019-12-31	$21,810
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$-8,321,870
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$7,166,952
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$15,488,822
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$20,812
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$5,661,155
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$12,633,786
Interest earned on other investments	2019-12-31	$54,363
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$54,466
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$54,466
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$283
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,505,797
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$2,800,570
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$2,549,561
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$10,987,312
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	2019-12-31	No
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	BLUE & CO., LLC
Accountancy firm EIN	2019-12-31	351178661
2018 : DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$-639,544
Total of all expenses incurred	2018-12-31	$2,890,425
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$2,886,123
Value of total assets at end of year	2018-12-31	$15,488,822
Value of total assets at beginning of year	2018-12-31	$19,018,791
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$4,302
Total interest from all sources	2018-12-31	$63,746
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$273,936
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$273,936
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2018-12-31	$0
Minimum employer required contribution for this plan year	2018-12-31	$0
Amount contributed by the employer to the plan for this plan year	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Administrative expenses (other) incurred	2018-12-31	$4,302
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-3,529,969
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$15,488,822
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$19,018,791
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$12,633,786
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$15,626,407
Interest earned on other investments	2018-12-31	$63,572
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$54,466
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$56,704
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$56,704
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$174
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$2,800,570
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$3,335,680
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-977,226
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$2,886,123
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	2018-12-31	No
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	BKD LLP
Accountancy firm EIN	2018-12-31	440160260
2017 : DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$2,549,901
Total of all expenses incurred	2017-12-31	$2,297,952
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$2,295,952
Value of total assets at end of year	2017-12-31	$19,018,791
Value of total assets at beginning of year	2017-12-31	$18,766,842
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$2,000
Total interest from all sources	2017-12-31	$64,168
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$272,030
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$272,030
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2017-12-31	$0
Minimum employer required contribution for this plan year	2017-12-31	$0
Amount contributed by the employer to the plan for this plan year	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Administrative expenses (other) incurred	2017-12-31	$2,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$251,949
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$19,018,791
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$18,766,842
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$15,626,407
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$14,915,634
Interest earned on other investments	2017-12-31	$64,121
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$56,704
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$55,620
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$55,620
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$47
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$3,335,680
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$3,795,588
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$2,213,703
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$2,295,952
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	2017-12-31	No
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	BKD LLP
Accountancy firm EIN	2017-12-31	440160260
2016 : DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2016 401k financial data
Total income from all sources (including contributions)	2016-12-31	$1,257,817
Total of all expenses incurred	2016-12-31	$1,819,850
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$1,811,566
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$33,778
Value of total assets at end of year	2016-12-31	$18,766,842
Value of total assets at beginning of year	2016-12-31	$19,328,875
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$8,284
Total interest from all sources	2016-12-31	$13,284
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$250,317
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$250,317
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2016-12-31	$0
Minimum employer required contribution for this plan year	2016-12-31	$19,848
Amount contributed by the employer to the plan for this plan year	2016-12-31	$19,848
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Administrative expenses (other) incurred	2016-12-31	$8,284
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-562,033
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$18,766,842
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$19,328,875
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$14,915,634
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$19,287,190
Interest earned on other investments	2016-12-31	$13,284
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$55,620
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$41,685
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$41,685
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$3,795,588
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$960,438
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$33,778
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$1,811,566
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	2016-12-31	No
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	BKD LLP
Accountancy firm EIN	2016-12-31	440160260
2015 : DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2015 401k financial data
Total income from all sources (including contributions)	2015-12-31	$-30,025
Total of all expenses incurred	2015-12-31	$2,276,276
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$2,266,387
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$144,742
Value of total assets at end of year	2015-12-31	$19,328,875
Value of total assets at beginning of year	2015-12-31	$21,635,176
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$9,889
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$271,912
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	$271,912
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
Funding deficiency by the employer to the plan for this plan year	2015-12-31	$0
Minimum employer required contribution for this plan year	2015-12-31	$144,738
Amount contributed by the employer to the plan for this plan year	2015-12-31	$144,738
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Administrative expenses (other) incurred	2015-12-31	$9,889
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	$-2,306,301
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$19,328,875
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$21,635,176
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	$19,287,190
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$21,593,495
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$41,685
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$41,681
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$41,681
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-446,679
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
Contributions received in cash from employer	2015-12-31	$144,742
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$2,266,387
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	2015-12-31	No
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	BKD LLP
Accountancy firm EIN	2015-12-31	440160260
2014 : DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2014 401k financial data
Total income from all sources (including contributions)	2014-12-31	$2,171,996
Total of all expenses incurred	2014-12-31	$1,701,204
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$1,689,770
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,070,889
Value of total assets at end of year	2014-12-31	$21,635,176
Value of total assets at beginning of year	2014-12-31	$21,164,384
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$11,434
Total interest from all sources	2014-12-31	$3
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$284,152
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	$284,152
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
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$1,070,886
Amount contributed by the employer to the plan for this plan year	2014-12-31	$1,070,886
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Administrative expenses (other) incurred	2014-12-31	$11,434
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	$470,792
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$21,635,176
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$21,164,384
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	$21,593,495
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$21,139,495
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$41,681
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$24,889
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$24,889
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$3
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$816,952
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
Contributions received in cash from employer	2014-12-31	$1,070,889
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$1,689,770
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	2014-12-31	No
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	BKD LLP
Accountancy firm EIN	2014-12-31	440160260
2013 : DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2013 401k financial data
Total income from all sources (including contributions)	2013-12-31	$3,830,068
Total of all expenses incurred	2013-12-31	$1,302,839
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,292,898
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$977,222
Value of total assets at end of year	2013-12-31	$21,164,384
Value of total assets at beginning of year	2013-12-31	$18,637,155
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$9,941
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$252,554
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	$252,554
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
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$977,218
Amount contributed by the employer to the plan for this plan year	2013-12-31	$977,218
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Administrative expenses (other) incurred	2013-12-31	$9,941
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	$2,527,229
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$21,164,384
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$18,637,155
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	$21,139,495
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$18,587,130
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$24,889
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$50,025
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$50,025
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$2,600,292
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
Contributions received in cash from employer	2013-12-31	$977,222
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,292,898
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	BKD LLP
Accountancy firm EIN	2013-12-31	440160260
2012 : DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$2,519,156
Total of all expenses incurred	2012-12-31	$847,512
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$838,432
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$926,299
Value of total assets at end of year	2012-12-31	$18,637,155
Value of total assets at beginning of year	2012-12-31	$16,965,511
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$9,080
Total interest from all sources	2012-12-31	$3
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$261,341
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	$261,341
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
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$926,299
Amount contributed by the employer to the plan for this plan year	2012-12-31	$926,299
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Administrative expenses (other) incurred	2012-12-31	$9,080
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	$1,671,644
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$18,637,155
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$16,965,511
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	$18,587,130
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$16,942,662
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$50,025
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$22,849
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$22,849
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$3
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$1,331,513
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	$926,299
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$838,432
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	BKD LLP
Accountancy firm EIN	2012-12-31	440160260
2011 : DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2011 401k financial data
Total income from all sources (including contributions)	2011-12-31	$567,504
Total of all expenses incurred	2011-12-31	$1,314,126
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,305,385
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$778,013
Value of total assets at end of year	2011-12-31	$16,965,511
Value of total assets at beginning of year	2011-12-31	$17,712,133
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$8,741
Total interest from all sources	2011-12-31	$4
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$217,725
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	$217,725
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
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$778,013
Amount contributed by the employer to the plan for this plan year	2011-12-31	$778,013
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Administrative expenses (other) incurred	2011-12-31	$8,741
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	$-746,622
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$16,965,511
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$17,712,133
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	$16,942,662
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$17,671,303
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$22,849
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$40,830
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$40,830
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$4
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-428,238
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$778,013
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,305,385
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	BKD LLP
Accountancy firm EIN	2011-12-31	440160260
2010 : DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$2,619,667
Total of all expenses incurred	2010-12-31	$999,780
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$987,086
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$1,250,167
Value of total assets at end of year	2010-12-31	$17,712,133
Value of total assets at beginning of year	2010-12-31	$16,092,246
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$12,694
Total interest from all sources	2010-12-31	$4
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$230,142
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	$230,142
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
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$1,250,167
Amount contributed by the employer to the plan for this plan year	2010-12-31	$1,250,167
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Administrative expenses (other) incurred	2010-12-31	$12,694
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	$1,619,887
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$17,712,133
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$16,092,246
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	$17,671,303
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$16,068,720
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$40,830
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$23,526
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$23,526
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$4
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$1,139,354
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	$1,250,167
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$987,086
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	BKD LLP
Accountancy firm EIN	2010-12-31	440160260
2009 : DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE 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
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$1,214,849
Amount contributed by the employer to the plan for this plan year	2009-12-31	$1,214,849

Form 5500 Responses for DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN

2020: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	This submission is the final filing	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2017: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: DEKALB MEMORIAL HOSPITAL, INC. MONEY PURCHASE 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

Insurance Providers Used on plan

STANDARD (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	TA080276
Policy instance	1
STANDARD (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	TA080276
Policy instance	1
STANDARD (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	TA080276
Policy instance	1

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Company Name:	DEKALB MEMORIAL HOSPITAL, INC.
Employer identification number (EIN):	351064295
NAIC Classification:	622000
NAIC Description:	Hospitals