401k Plan data: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN plan

MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN
Plan identification number	001

MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

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

Company Name: MENDOTA COMMUNITY HOSPITAL

Employer identification number (EIN): 362167785

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 KIMBERLY KENNEDY KIMBERLY KENNEDY 2017-06-14
001 2015-01-01 KIM KENNEDY KIM KENNEDY 2016-10-16
001 2014-01-01 KIM KENNEDY KIM KENNEDY 2015-07-31
001 2013-01-01 KIMBERLY KENNEDY KIMBERLY KENNEDY 2014-06-30
001 2012-01-01 KIM KENNEDY KIM KENNEDY 2013-10-10
001 2011-01-01 KIM KENNEDY KIM KENNEDY 2012-07-19
001 2010-01-01 KIM KENNEDY KIM KENNEDY 2011-09-01
001 2009-01-01 KIM KENNEDY KIM KENNEDY 2010-07-26

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	KIMBERLY KENNEDY	KIMBERLY KENNEDY	2017-06-14
001	2015-01-01	KIM KENNEDY	KIM KENNEDY	2016-10-16
001	2014-01-01	KIM KENNEDY	KIM KENNEDY	2015-07-31
001	2013-01-01	KIMBERLY KENNEDY	KIMBERLY KENNEDY	2014-06-30
001	2012-01-01	KIM KENNEDY	KIM KENNEDY	2013-10-10
001	2011-01-01	KIM KENNEDY	KIM KENNEDY	2012-07-19
001	2010-01-01	KIM KENNEDY	KIM KENNEDY	2011-09-01
001	2009-01-01	KIM KENNEDY	KIM KENNEDY	2010-07-26

Plan Statistics for MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN

Measure Date Value
2016: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 293
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: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 333
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 260
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 30
Total of all active and inactive participants 2015-01-01 290
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 290
Number of participants with account balances 2015-01-01 194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 343
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 310
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 23
Total of all active and inactive participants 2014-01-01 333
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 333
Number of participants with account balances 2014-01-01 219
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 2
2013: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 342
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 331
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 16
Total of all active and inactive participants 2013-01-01 347
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 347
Number of participants with account balances 2013-01-01 231
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 19
2012: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 341
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 347
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 10
Total of all active and inactive participants 2012-01-01 357
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 357
Number of participants with account balances 2012-01-01 229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 7
2011: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 331
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 307
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 12
Total of all active and inactive participants 2011-01-01 319
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 319
Number of participants with account balances 2011-01-01 231
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 348
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 305
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 7
Total of all active and inactive participants 2010-01-01 312
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 312
Number of participants with account balances 2010-01-01 227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 280
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 258
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 21
Total of all active and inactive participants 2009-01-01 279
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 279
Number of participants with account balances 2009-01-01 231
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2016: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	293
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: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	333
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	260
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	30
Total of all active and inactive participants	2015-01-01	290
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	290
Number of participants with account balances	2015-01-01	194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	343
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	310
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	23
Total of all active and inactive participants	2014-01-01	333
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	333
Number of participants with account balances	2014-01-01	219
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	2
2013: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	342
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	331
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	16
Total of all active and inactive participants	2013-01-01	347
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	347
Number of participants with account balances	2013-01-01	231
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	19
2012: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	341
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	347
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	10
Total of all active and inactive participants	2012-01-01	357
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	357
Number of participants with account balances	2012-01-01	229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	7
2011: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	331
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	307
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	12
Total of all active and inactive participants	2011-01-01	319
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	319
Number of participants with account balances	2011-01-01	231
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	348
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	305
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	7
Total of all active and inactive participants	2010-01-01	312
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	312
Number of participants with account balances	2010-01-01	227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	280
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	258
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	21
Total of all active and inactive participants	2009-01-01	279
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	279
Number of participants with account balances	2009-01-01	231
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN

Measure	Date	Value
2016 : MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2016 401k financial data
Unrealized appreciation/depreciation of real estate assets	2016-08-04	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2016-08-04	$0
Total unrealized appreciation/depreciation of assets	2016-08-04	$0
Total transfer of assets to this plan	2016-08-04	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-08-04	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-08-04	$0
Total income from all sources (including contributions)	2016-08-04	$278,454
Total loss/gain on sale of assets	2016-08-04	$0
Total of all expenses incurred	2016-08-04	$12,470,568
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-08-04	$12,461,326
Expenses. Certain deemed distributions of participant loans	2016-08-04	$0
Value of total corrective distributions	2016-08-04	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-08-04	$7,808
Value of total assets at end of year	2016-08-04	$0
Value of total assets at beginning of year	2016-08-04	$12,192,114
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-08-04	$9,242
Total income from rents	2016-08-04	$0
Total interest from all sources	2016-08-04	$27,539
Total dividends received (eg from common stock, registered investment company shares)	2016-08-04	$8,379
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-08-04	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-08-04	$8,379
Administrative expenses professional fees incurred	2016-08-04	$0
Was this plan covered by a fidelity bond	2016-08-04	Yes
Value of fidelity bond cover	2016-08-04	$1,000,000
If this is an individual account plan, was there a blackout period	2016-08-04	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-08-04	$0
Were there any nonexempt tranactions with any party-in-interest	2016-08-04	No
Amount of non-exempt transactions with any party-in-interest	2016-08-04	$0
Contributions received from participants	2016-08-04	$0
Participant contributions at end of year	2016-08-04	$0
Participant contributions at beginning of year	2016-08-04	$134,800
Participant contributions at end of year	2016-08-04	$0
Participant contributions at beginning of year	2016-08-04	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-08-04	$4,681
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2016-08-04	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-08-04	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-08-04	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-08-04	$0
Other income not declared elsewhere	2016-08-04	$0
Administrative expenses (other) incurred	2016-08-04	$0
Liabilities. Value of operating payables at beginning of year	2016-08-04	$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	2016-08-04	No
Value of net income/loss	2016-08-04	$-12,192,114
Value of net assets at end of year (total assets less liabilities)	2016-08-04	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-08-04	$12,192,114
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-08-04	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-08-04	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2016-08-04	$0
Were any leases to which the plan was party in default or uncollectible	2016-08-04	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2016-08-04	$0
Investment advisory and management fees	2016-08-04	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-08-04	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-08-04	$9,554,315
Interest on participant loans	2016-08-04	$3,031
Income. Interest from loans (other than to participants)	2016-08-04	$0
Interest earned on other investments	2016-08-04	$24,508
Income. Interest from US Government securities	2016-08-04	$0
Income. Interest from corporate debt instruments	2016-08-04	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-08-04	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-08-04	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-08-04	$2,502,999
Expenses. Payments to insurance carriers foe the provision of benefits	2016-08-04	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-08-04	$234,728
Net investment gain/loss from pooled separate accounts	2016-08-04	$0
Net investment gain or loss from common/collective trusts	2016-08-04	$0
Net gain/loss from 103.12 investment entities	2016-08-04	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-08-04	No
Was there a failure to transmit to the plan any participant contributions	2016-08-04	No
Has the plan failed to provide any benefit when due under the plan	2016-08-04	No
Contributions received in cash from employer	2016-08-04	$3,127
Employer contributions (assets) at end of year	2016-08-04	$0
Employer contributions (assets) at beginning of year	2016-08-04	$0
Income. Dividends from preferred stock	2016-08-04	$0
Income. Dividends from common stock	2016-08-04	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-08-04	$12,461,326
Contract administrator fees	2016-08-04	$9,242
Liabilities. Value of benefit claims payable at beginning of year	2016-08-04	$0
Did the plan have assets held for investment	2016-08-04	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	2016-08-04	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-08-04	Yes
Aggregate proceeds on sale of assets	2016-08-04	$0
Aggregate carrying amount (costs) on sale of assets	2016-08-04	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2016-08-04	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-08-04	Yes
Opinion of an independent qualified public accountant for this plan	2016-08-04	Disclaimer
Accountancy firm name	2016-08-04	BKD, LLP
Accountancy firm EIN	2016-08-04	440016026
2015 : MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets	2015-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2015-12-31	$0
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets to this plan	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	$436,581
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$2,723,203
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$2,717,181
Expenses. Certain deemed distributions of participant loans	2015-12-31	$3,242
Value of total corrective distributions	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$352,448
Value of total assets at end of year	2015-12-31	$12,192,114
Value of total assets at beginning of year	2015-12-31	$14,478,736
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$2,780
Total income from rents	2015-12-31	$0
Total interest from all sources	2015-12-31	$76,489
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$120,934
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	$120,934
Administrative expenses professional fees incurred	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
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
Amount of non-exempt transactions with any party-in-interest	2015-12-31	$0
Contributions received from participants	2015-12-31	$263,450
Participant contributions at end of year	2015-12-31	$134,800
Participant contributions at beginning of year	2015-12-31	$143,298
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$12,613
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-12-31	$13,846
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Other income not declared elsewhere	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$0
Liabilities. Value of operating payables at beginning of year	2015-12-31	$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	2015-12-31	No
Value of net income/loss	2015-12-31	$-2,286,622
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$12,192,114
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$14,478,736
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2015-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2015-12-31	$0
Investment advisory and management fees	2015-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$9,554,315
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$11,417,705
Interest on participant loans	2015-12-31	$7,117
Income. Interest from loans (other than to participants)	2015-12-31	$0
Interest earned on other investments	2015-12-31	$69,372
Income. Interest from US Government securities	2015-12-31	$0
Income. Interest from corporate debt instruments	2015-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$2,502,999
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$2,917,733
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-113,290
Net investment gain/loss from pooled separate accounts	2015-12-31	$0
Net investment gain or loss from common/collective trusts	2015-12-31	$0
Net gain/loss from 103.12 investment entities	2015-12-31	$0
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	$76,385
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$0
Income. Dividends from preferred stock	2015-12-31	$0
Income. Dividends from common stock	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$2,703,335
Contract administrator fees	2015-12-31	$2,780
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$0
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
Aggregate proceeds on sale of assets	2015-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2015-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2015-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Qualified
Accountancy firm name	2015-12-31	BKD
Accountancy firm EIN	2015-12-31	440160260
2014 : MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2014 401k financial data
Unrealized appreciation/depreciation of real estate assets	2014-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$0
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total transfer of assets to this plan	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	$1,904,280
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$1,165,431
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$1,155,861
Expenses. Certain deemed distributions of participant loans	2014-12-31	$0
Value of total corrective distributions	2014-12-31	$6,908
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,070,221
Value of total assets at end of year	2014-12-31	$14,478,736
Value of total assets at beginning of year	2014-12-31	$13,739,887
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$2,662
Total income from rents	2014-12-31	$0
Total interest from all sources	2014-12-31	$84,376
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$201,494
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	$201,494
Administrative expenses professional fees incurred	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
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
Amount of non-exempt transactions with any party-in-interest	2014-12-31	$0
Contributions received from participants	2014-12-31	$785,562
Participant contributions at end of year	2014-12-31	$143,298
Participant contributions at beginning of year	2014-12-31	$146,461
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$31,676
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$0
Other income not declared elsewhere	2014-12-31	$730
Administrative expenses (other) incurred	2014-12-31	$0
Liabilities. Value of operating payables at beginning of year	2014-12-31	$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	2014-12-31	No
Value of net income/loss	2014-12-31	$738,849
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$14,478,736
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$13,739,887
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2014-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2014-12-31	$0
Investment advisory and management fees	2014-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$11,417,705
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$11,082,707
Interest on participant loans	2014-12-31	$7,489
Income. Interest from loans (other than to participants)	2014-12-31	$0
Interest earned on other investments	2014-12-31	$76,887
Income. Interest from US Government securities	2014-12-31	$0
Income. Interest from corporate debt instruments	2014-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$2,917,733
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$2,510,719
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$547,459
Net investment gain/loss from pooled separate accounts	2014-12-31	$0
Net investment gain or loss from common/collective trusts	2014-12-31	$0
Net gain/loss from 103.12 investment entities	2014-12-31	$0
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	$252,983
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$0
Income. Dividends from preferred stock	2014-12-31	$0
Income. Dividends from common stock	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$1,155,861
Contract administrator fees	2014-12-31	$2,662
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$0
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
Aggregate proceeds on sale of assets	2014-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2014-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2014-12-31	$0
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 : MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2013 401k financial data
Unrealized appreciation/depreciation of real estate assets	2013-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2013-12-31	$0
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total transfer of assets to this plan	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	$3,250,122
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$1,758,549
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,751,472
Expenses. Certain deemed distributions of participant loans	2013-12-31	$3,888
Value of total corrective distributions	2013-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$1,229,598
Value of total assets at end of year	2013-12-31	$13,739,887
Value of total assets at beginning of year	2013-12-31	$12,248,314
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$3,189
Total income from rents	2013-12-31	$0
Total interest from all sources	2013-12-31	$73,753
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$146,219
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	$146,219
Administrative expenses professional fees incurred	2013-12-31	$0
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Amount of non-exempt transactions with any party-in-interest	2013-12-31	$0
Contributions received from participants	2013-12-31	$888,412
Participant contributions at end of year	2013-12-31	$146,461
Participant contributions at beginning of year	2013-12-31	$123,836
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$31,692
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$0
Other income not declared elsewhere	2013-12-31	$0
Administrative expenses (other) incurred	2013-12-31	$0
Liabilities. Value of operating payables at beginning of year	2013-12-31	$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	2013-12-31	No
Value of net income/loss	2013-12-31	$1,491,573
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$13,739,887
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$12,248,314
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2013-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2013-12-31	$0
Investment advisory and management fees	2013-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$11,082,707
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$9,940,900
Interest on participant loans	2013-12-31	$7,118
Income. Interest from loans (other than to participants)	2013-12-31	$0
Interest earned on other investments	2013-12-31	$66,635
Income. Interest from US Government securities	2013-12-31	$0
Income. Interest from corporate debt instruments	2013-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$2,510,719
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$2,183,578
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$1,800,552
Net investment gain/loss from pooled separate accounts	2013-12-31	$0
Net investment gain or loss from common/collective trusts	2013-12-31	$0
Net gain/loss from 103.12 investment entities	2013-12-31	$0
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	$309,494
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$0
Income. Dividends from preferred stock	2013-12-31	$0
Income. Dividends from common stock	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,751,472
Contract administrator fees	2013-12-31	$3,189
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$0
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
Aggregate proceeds on sale of assets	2013-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2013-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2013-12-31	$0
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 : MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2012 401k financial data
Unrealized appreciation/depreciation of real estate assets	2012-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$0
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total transfer of assets to this plan	2012-12-31	$0
Total transfer of assets from this plan	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	$2,610,809
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$355,041
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$353,595
Expenses. Certain deemed distributions of participant loans	2012-12-31	$0
Value of total corrective distributions	2012-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$1,315,891
Value of total assets at end of year	2012-12-31	$12,248,314
Value of total assets at beginning of year	2012-12-31	$9,992,546
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$1,446
Total income from rents	2012-12-31	$0
Total interest from all sources	2012-12-31	$64,131
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$155,296
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	$155,296
Administrative expenses professional fees incurred	2012-12-31	$0
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Amount of non-exempt transactions with any party-in-interest	2012-12-31	$0
Contributions received from participants	2012-12-31	$896,004
Participant contributions at end of year	2012-12-31	$123,836
Participant contributions at beginning of year	2012-12-31	$79,446
Participant contributions at end of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$125,750
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$0
Other income not declared elsewhere	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$0
Liabilities. Value of operating payables at beginning of year	2012-12-31	$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	2012-12-31	No
Value of net income/loss	2012-12-31	$2,255,768
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$12,248,314
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$9,992,546
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2012-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2012-12-31	$0
Investment advisory and management fees	2012-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$9,940,900
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$8,030,853
Interest on participant loans	2012-12-31	$5,339
Income. Interest from loans (other than to participants)	2012-12-31	$0
Interest earned on other investments	2012-12-31	$58,792
Income. Interest from US Government securities	2012-12-31	$0
Income. Interest from corporate debt instruments	2012-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$2,183,578
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$1,882,247
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$1,075,491
Net investment gain/loss from pooled separate accounts	2012-12-31	$0
Net investment gain or loss from common/collective trusts	2012-12-31	$0
Net gain/loss from 103.12 investment entities	2012-12-31	$0
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	$294,137
Employer contributions (assets) at end of year	2012-12-31	$0
Employer contributions (assets) at beginning of year	2012-12-31	$0
Income. Dividends from preferred stock	2012-12-31	$0
Income. Dividends from common stock	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$353,595
Contract administrator fees	2012-12-31	$1,446
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$0
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
Aggregate proceeds on sale of assets	2012-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2012-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2012-12-31	$0
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 : MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2011 401k financial data
Unrealized appreciation/depreciation of real estate assets	2011-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$0
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets to this plan	2011-12-31	$0
Total transfer of assets from this plan	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	$1,033,377
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$424,708
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$422,948
Expenses. Certain deemed distributions of participant loans	2011-12-31	$0
Value of total corrective distributions	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$1,141,277
Value of total assets at end of year	2011-12-31	$9,992,546
Value of total assets at beginning of year	2011-12-31	$9,383,877
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,760
Total income from rents	2011-12-31	$0
Total interest from all sources	2011-12-31	$60,040
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$121,298
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	$121,298
Administrative expenses professional fees incurred	2011-12-31	$0
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
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
Amount of non-exempt transactions with any party-in-interest	2011-12-31	$0
Contributions received from participants	2011-12-31	$860,672
Participant contributions at end of year	2011-12-31	$79,446
Participant contributions at beginning of year	2011-12-31	$41,533
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$0
Other income not declared elsewhere	2011-12-31	$0
Administrative expenses (other) incurred	2011-12-31	$0
Liabilities. Value of operating payables at beginning of year	2011-12-31	$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	2011-12-31	No
Value of net income/loss	2011-12-31	$608,669
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$9,992,546
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$9,383,877
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2011-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2011-12-31	$0
Investment advisory and management fees	2011-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$8,030,853
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$7,413,891
Interest on participant loans	2011-12-31	$3,836
Income. Interest from loans (other than to participants)	2011-12-31	$0
Interest earned on other investments	2011-12-31	$56,204
Income. Interest from US Government securities	2011-12-31	$0
Income. Interest from corporate debt instruments	2011-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$1,882,247
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$1,928,453
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-289,238
Net investment gain/loss from pooled separate accounts	2011-12-31	$0
Net investment gain or loss from common/collective trusts	2011-12-31	$0
Net gain/loss from 103.12 investment entities	2011-12-31	$0
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	$280,605
Employer contributions (assets) at end of year	2011-12-31	$0
Employer contributions (assets) at beginning of year	2011-12-31	$0
Income. Dividends from preferred stock	2011-12-31	$0
Income. Dividends from common stock	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$422,948
Contract administrator fees	2011-12-31	$1,760
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$0
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
Aggregate proceeds on sale of assets	2011-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2011-12-31	$0
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 LTD
Accountancy firm EIN	2011-12-31	440160260
2010 : MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2010 401k financial data
Unrealized appreciation/depreciation of real estate assets	2010-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$0
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$0
Total transfer of assets from this plan	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	$4,177,767
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$219,576
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$218,108
Expenses. Certain deemed distributions of participant loans	2010-12-31	$0
Value of total corrective distributions	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$3,291,019
Value of total assets at end of year	2010-12-31	$9,383,877
Value of total assets at beginning of year	2010-12-31	$5,425,686
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,468
Total income from rents	2010-12-31	$0
Total interest from all sources	2010-12-31	$43,713
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$87,358
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	$87,358
Administrative expenses professional fees incurred	2010-12-31	$0
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Amount of non-exempt transactions with any party-in-interest	2010-12-31	$0
Contributions received from participants	2010-12-31	$800,909
Participant contributions at end of year	2010-12-31	$41,533
Participant contributions at beginning of year	2010-12-31	$30,539
Participant contributions at end of year	2010-12-31	$0
Participant contributions at beginning of year	2010-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$2,413,795
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$0
Administrative expenses (other) incurred	2010-12-31	$0
Liabilities. Value of operating payables at beginning of year	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	$3,958,191
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$9,383,877
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$5,425,686
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2010-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2010-12-31	$0
Investment advisory and management fees	2010-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$7,413,891
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$4,256,624
Interest on participant loans	2010-12-31	$2,021
Income. Interest from loans (other than to participants)	2010-12-31	$0
Interest earned on other investments	2010-12-31	$41,692
Income. Interest from US Government securities	2010-12-31	$0
Income. Interest from corporate debt instruments	2010-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$1,928,453
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$1,138,523
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$755,677
Net investment gain/loss from pooled separate accounts	2010-12-31	$0
Net investment gain or loss from common/collective trusts	2010-12-31	$0
Net gain/loss from 103.12 investment entities	2010-12-31	$0
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	$76,315
Employer contributions (assets) at end of year	2010-12-31	$0
Employer contributions (assets) at beginning of year	2010-12-31	$0
Income. Dividends from preferred stock	2010-12-31	$0
Income. Dividends from common stock	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$218,108
Contract administrator fees	2010-12-31	$1,468
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$0
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
Aggregate proceeds on sale of assets	2010-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2010-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2010-12-31	$0
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 : MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN

2016: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
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: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
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: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
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: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
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: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
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
2010: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: MENDOTA COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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

441463

Policy instance

Insurance contract or identification number	441463
Number of Individuals Covered	290
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,056
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,056
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	TBS AGENCY INC

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

Policy contract number

441463

Policy instance

Insurance contract or identification number	441463
Number of Individuals Covered	333
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,683
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,683
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	SUNSET FINANCIAL SERVICES INC

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

Policy contract number

441463

Policy instance

Insurance contract or identification number	441463
Number of Individuals Covered	347
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $26,629
Total amount of fees paid to insurance company	USD $4,257
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,629
Amount paid for insurance broker fees	4257
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	SUNSET FINANCIAL SERVICES INC

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

Policy contract number

441463

Policy instance

Insurance contract or identification number	441463
Number of Individuals Covered	357
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $17,556
Total amount of fees paid to insurance company	USD $2,719
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,873
Amount paid for insurance broker fees	1830
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	SUNSET FINANCIAL SERVICES INC

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

Policy contract number

441463

Policy instance

Insurance contract or identification number	441463
Number of Individuals Covered	319
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $21,386
Total amount of fees paid to insurance company	USD $3,194
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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

441463

Policy instance

Insurance contract or identification number	441463
Number of Individuals Covered	312
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $14,964
Total amount of fees paid to insurance company	USD $1,567
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,964
Amount paid for insurance broker fees	1567
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	SUNSET FINANCIAL SERVICES INC

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Company Name:	MENDOTA COMMUNITY HOSPITAL
Employer identification number (EIN):	362167785
NAIC Classification:	622000
NAIC Description:	Hospitals