401k Plan data: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN plan

IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 401k Plan overview

Plan Name	IROQUOIS MEMORIAL HOSPITAL PENSION PLAN
Plan identification number	001

IROQUOIS MEMORIAL HOSPITAL PENSION 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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

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

Company Name: IROQUOIS MEMORIAL HOSPITAL

Employer identification number (EIN): 370673512

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IROQUOIS MEMORIAL HOSPITAL PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-10-01 LORI YELENICK
001 2013-10-01 LORI YELENICK
001 2012-10-01 THOMAS W MCCANN
001 2011-10-01 THOMAS W MCCANN
001 2009-10-01 THOMAS W. MCCANN
001 2008-10-01
001 2007-10-01 THOMAS W. MCCANN THOMAS W. MCCANN 2010-08-18

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2014-10-01	LORI YELENICK
001	2013-10-01	LORI YELENICK
001	2012-10-01	THOMAS W MCCANN
001	2011-10-01	THOMAS W MCCANN
001	2009-10-01	THOMAS W. MCCANN
001	2008-10-01
001	2007-10-01	THOMAS W. MCCANN	THOMAS W. MCCANN	2010-08-18

Plan Statistics for IROQUOIS MEMORIAL HOSPITAL PENSION PLAN

401k plan membership statisitcs for IROQUOIS MEMORIAL HOSPITAL PENSION PLAN

Measure Date Value
2014: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 223
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 0
Number of retired or separated participants receiving benefits 2014-10-01 0
Number of other retired or separated participants entitled to future benefits 2014-10-01 0
Total of all active and inactive participants 2014-10-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-10-01 0
Total participants 2014-10-01 0
Number of participants with account balances 2014-10-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-10-01 0
2013: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 242
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 197
Number of retired or separated participants receiving benefits 2013-10-01 2
Number of other retired or separated participants entitled to future benefits 2013-10-01 21
Total of all active and inactive participants 2013-10-01 220
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-10-01 0
Total participants 2013-10-01 220
Number of participants with account balances 2013-10-01 220
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-10-01 0
2012: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 284
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 221
Number of retired or separated participants receiving benefits 2012-10-01 2
Number of other retired or separated participants entitled to future benefits 2012-10-01 19
Total of all active and inactive participants 2012-10-01 242
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-10-01 0
Total participants 2012-10-01 242
Number of participants with account balances 2012-10-01 242
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-10-01 0
2011: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 308
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 250
Number of retired or separated participants receiving benefits 2011-10-01 2
Number of other retired or separated participants entitled to future benefits 2011-10-01 32
Total of all active and inactive participants 2011-10-01 284
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-10-01 0
Total participants 2011-10-01 284
Number of participants with account balances 2011-10-01 276
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-10-01 0
2009: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 361
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 276
Number of retired or separated participants receiving benefits 2009-10-01 2
Number of other retired or separated participants entitled to future benefits 2009-10-01 26
Total of all active and inactive participants 2009-10-01 304
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-10-01 0
Total participants 2009-10-01 304
Number of participants with account balances 2009-10-01 304
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-10-01 4
2007: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2007 401k membership
Total participants, beginning-of-year 2007-10-01 436
Total number of active participants reported on line 7a of the Form 5500 2007-10-01 383
Number of retired or separated participants receiving benefits 2007-10-01 4
Number of other retired or separated participants entitled to future benefits 2007-10-01 48
Total of all active and inactive participants 2007-10-01 435
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2007-10-01 0
Total participants 2007-10-01 435
Number of participants with account balances 2007-10-01 394
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2007-10-01 8

Measure	Date	Value
2014: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	223
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	0
Number of retired or separated participants receiving benefits	2014-10-01	0
Number of other retired or separated participants entitled to future benefits	2014-10-01	0
Total of all active and inactive participants	2014-10-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-10-01	0
Total participants	2014-10-01	0
Number of participants with account balances	2014-10-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-10-01	0
2013: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	242
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	197
Number of retired or separated participants receiving benefits	2013-10-01	2
Number of other retired or separated participants entitled to future benefits	2013-10-01	21
Total of all active and inactive participants	2013-10-01	220
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-10-01	0
Total participants	2013-10-01	220
Number of participants with account balances	2013-10-01	220
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-10-01	0
2012: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	284
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	221
Number of retired or separated participants receiving benefits	2012-10-01	2
Number of other retired or separated participants entitled to future benefits	2012-10-01	19
Total of all active and inactive participants	2012-10-01	242
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-10-01	0
Total participants	2012-10-01	242
Number of participants with account balances	2012-10-01	242
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-10-01	0
2011: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	308
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	250
Number of retired or separated participants receiving benefits	2011-10-01	2
Number of other retired or separated participants entitled to future benefits	2011-10-01	32
Total of all active and inactive participants	2011-10-01	284
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-10-01	0
Total participants	2011-10-01	284
Number of participants with account balances	2011-10-01	276
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-10-01	0
2009: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	361
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	276
Number of retired or separated participants receiving benefits	2009-10-01	2
Number of other retired or separated participants entitled to future benefits	2009-10-01	26
Total of all active and inactive participants	2009-10-01	304
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-10-01	0
Total participants	2009-10-01	304
Number of participants with account balances	2009-10-01	304
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-10-01	4
2007: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2007 401k membership
Total participants, beginning-of-year	2007-10-01	436
Total number of active participants reported on line 7a of the Form 5500	2007-10-01	383
Number of retired or separated participants receiving benefits	2007-10-01	4
Number of other retired or separated participants entitled to future benefits	2007-10-01	48
Total of all active and inactive participants	2007-10-01	435
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2007-10-01	0
Total participants	2007-10-01	435
Number of participants with account balances	2007-10-01	394
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2007-10-01	8

Financial Data on IROQUOIS MEMORIAL HOSPITAL PENSION PLAN

Measure	Date	Value
2015 : IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-08-31	$0
Total transfer of assets from this plan	2015-08-31	$6,732,785
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-08-31	$0
Total income from all sources (including contributions)	2015-08-31	$-40,449
Total loss/gain on sale of assets	2015-08-31	$0
Total of all expenses incurred	2015-08-31	$462,792
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-08-31	$430,234
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-08-31	$0
Value of total assets at end of year	2015-08-31	$0
Value of total assets at beginning of year	2015-08-31	$7,236,026
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-08-31	$32,558
Total interest from all sources	2015-08-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-08-31	No
Administrative expenses professional fees incurred	2015-08-31	$32,558
Was this plan covered by a fidelity bond	2015-08-31	Yes
Value of fidelity bond cover	2015-08-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-08-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-08-31	$0
Funding deficiency by the employer to the plan for this plan year	2015-08-31	$0
Minimum employer required contribution for this plan year	2015-08-31	$0
Amount contributed by the employer to the plan for this plan year	2015-08-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-08-31	No
Assets. Other investments not covered elsewhere at end of year	2015-08-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2015-08-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-08-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-08-31	$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	2015-08-31	No
Value of net income/loss	2015-08-31	$-503,241
Value of net assets at end of year (total assets less liabilities)	2015-08-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2015-08-31	$7,236,026
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-08-31	No
Were any leases to which the plan was party in default or uncollectible	2015-08-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-08-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-08-31	$0
Value of interest in pooled separate accounts at end of year	2015-08-31	$0
Value of interest in pooled separate accounts at beginning of year	2015-08-31	$7,236,026
Net investment gain/loss from pooled separate accounts	2015-08-31	$-40,449
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-08-31	No
Was there a failure to transmit to the plan any participant contributions	2015-08-31	No
Has the plan failed to provide any benefit when due under the plan	2015-08-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-08-31	$430,234
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	2015-08-31	Yes
Did the plan have assets held for investment	2015-08-31	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	2015-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-08-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-08-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-08-31	Disclaimer
Accountancy firm name	2015-08-31	KERBER ECK & BRAECKEL LLP
Accountancy firm EIN	2015-08-31	430352985
2014 : IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-09-30	$1,397
Total income from all sources (including contributions)	2014-09-30	$567,651
Total loss/gain on sale of assets	2014-09-30	$0
Total of all expenses incurred	2014-09-30	$357,707
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-09-30	$317,362
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-09-30	$0
Value of total assets at end of year	2014-09-30	$7,236,026
Value of total assets at beginning of year	2014-09-30	$7,027,479
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-09-30	$40,345
Total interest from all sources	2014-09-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-09-30	No
Was this plan covered by a fidelity bond	2014-09-30	Yes
Value of fidelity bond cover	2014-09-30	$1,000,000
If this is an individual account plan, was there a blackout period	2014-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-09-30	$0
Funding deficiency by the employer to the plan for this plan year	2014-09-30	$0
Minimum employer required contribution for this plan year	2014-09-30	$0
Amount contributed by the employer to the plan for this plan year	2014-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2014-09-30	No
Assets. Other investments not covered elsewhere at end of year	2014-09-30	$0
Assets. Other investments not covered elsewhere at beginning of year	2014-09-30	$1,397
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-09-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-09-30	$1,397
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-09-30	No
Value of net income/loss	2014-09-30	$209,944
Value of net assets at end of year (total assets less liabilities)	2014-09-30	$7,236,026
Value of net assets at beginning of year (total assets less liabilities)	2014-09-30	$7,026,082
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-09-30	No
Were any leases to which the plan was party in default or uncollectible	2014-09-30	No
Investment advisory and management fees	2014-09-30	$40,195
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-09-30	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-09-30	$0
Value of interest in pooled separate accounts at end of year	2014-09-30	$7,236,026
Value of interest in pooled separate accounts at beginning of year	2014-09-30	$7,026,082
Net investment gain/loss from pooled separate accounts	2014-09-30	$567,651
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-09-30	No
Was there a failure to transmit to the plan any participant contributions	2014-09-30	No
Has the plan failed to provide any benefit when due under the plan	2014-09-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-09-30	$317,362
Contract administrator fees	2014-09-30	$150
Did the plan have assets held for investment	2014-09-30	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	2014-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2014-09-30	Disclaimer
Accountancy firm name	2014-09-30	KERBER ECK & BRAECKEL LLP
Accountancy firm EIN	2014-09-30	430352985
2013 : IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-09-30	$1,397
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-09-30	$0
Total income from all sources (including contributions)	2013-09-30	$691,117
Total loss/gain on sale of assets	2013-09-30	$0
Total of all expenses incurred	2013-09-30	$417,564
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-09-30	$373,551
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-09-30	$0
Value of total assets at end of year	2013-09-30	$7,027,479
Value of total assets at beginning of year	2013-09-30	$6,752,529
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-09-30	$44,013
Total interest from all sources	2013-09-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-09-30	No
Was this plan covered by a fidelity bond	2013-09-30	Yes
Value of fidelity bond cover	2013-09-30	$1,000,000
If this is an individual account plan, was there a blackout period	2013-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-09-30	$0
Funding deficiency by the employer to the plan for this plan year	2013-09-30	$0
Minimum employer required contribution for this plan year	2013-09-30	$0
Amount contributed by the employer to the plan for this plan year	2013-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2013-09-30	No
Assets. Other investments not covered elsewhere at end of year	2013-09-30	$1,397
Assets. Other investments not covered elsewhere at beginning of year	2013-09-30	$1,777
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-09-30	$1,397
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-09-30	$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	2013-09-30	No
Value of net income/loss	2013-09-30	$273,553
Value of net assets at end of year (total assets less liabilities)	2013-09-30	$7,026,082
Value of net assets at beginning of year (total assets less liabilities)	2013-09-30	$6,752,529
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-09-30	No
Were any leases to which the plan was party in default or uncollectible	2013-09-30	No
Investment advisory and management fees	2013-09-30	$38,263
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-09-30	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-09-30	$0
Value of interest in pooled separate accounts at end of year	2013-09-30	$7,026,082
Value of interest in pooled separate accounts at beginning of year	2013-09-30	$6,750,752
Net investment gain/loss from pooled separate accounts	2013-09-30	$691,117
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-09-30	No
Was there a failure to transmit to the plan any participant contributions	2013-09-30	No
Has the plan failed to provide any benefit when due under the plan	2013-09-30	Yes
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-09-30	$373,551
Contract administrator fees	2013-09-30	$5,750
Did the plan have assets held for investment	2013-09-30	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	2013-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2013-09-30	Disclaimer
Accountancy firm name	2013-09-30	KERBER ECK & BRAECKEL LLP
Accountancy firm EIN	2013-09-30	430352985
2012 : IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$15,876
Total income from all sources (including contributions)	2012-09-30	$975,562
Total loss/gain on sale of assets	2012-09-30	$0
Total of all expenses incurred	2012-09-30	$365,259
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-09-30	$329,196
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-09-30	$0
Value of total assets at end of year	2012-09-30	$6,752,529
Value of total assets at beginning of year	2012-09-30	$6,158,102
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-09-30	$36,063
Total interest from all sources	2012-09-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-09-30	No
Was this plan covered by a fidelity bond	2012-09-30	Yes
Value of fidelity bond cover	2012-09-30	$500,000
If this is an individual account plan, was there a blackout period	2012-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-09-30	$0
Funding deficiency by the employer to the plan for this plan year	2012-09-30	$0
Minimum employer required contribution for this plan year	2012-09-30	$0
Amount contributed by the employer to the plan for this plan year	2012-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2012-09-30	No
Assets. Other investments not covered elsewhere at end of year	2012-09-30	$1,777
Assets. Other investments not covered elsewhere at beginning of year	2012-09-30	$50,869
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-09-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-09-30	$15,876
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-09-30	No
Value of net income/loss	2012-09-30	$610,303
Value of net assets at end of year (total assets less liabilities)	2012-09-30	$6,752,529
Value of net assets at beginning of year (total assets less liabilities)	2012-09-30	$6,142,226
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-09-30	No
Were any leases to which the plan was party in default or uncollectible	2012-09-30	No
Investment advisory and management fees	2012-09-30	$35,988
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-09-30	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-09-30	$0
Value of interest in pooled separate accounts at end of year	2012-09-30	$6,750,752
Value of interest in pooled separate accounts at beginning of year	2012-09-30	$6,107,233
Net investment gain/loss from pooled separate accounts	2012-09-30	$975,562
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-09-30	No
Was there a failure to transmit to the plan any participant contributions	2012-09-30	No
Has the plan failed to provide any benefit when due under the plan	2012-09-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-09-30	$329,196
Contract administrator fees	2012-09-30	$75
Did the plan have assets held for investment	2012-09-30	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	2012-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2012-09-30	Disclaimer
Accountancy firm name	2012-09-30	KERBER ECK & BRAECKEL LLP
Accountancy firm EIN	2012-09-30	430352985
2011 : IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$15,876
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$0
Total income from all sources (including contributions)	2011-09-30	$126,140
Total loss/gain on sale of assets	2011-09-30	$0
Total of all expenses incurred	2011-09-30	$557,913
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-09-30	$501,119
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-09-30	$209,773
Value of total assets at end of year	2011-09-30	$6,158,102
Value of total assets at beginning of year	2011-09-30	$6,573,999
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-09-30	$56,794
Total interest from all sources	2011-09-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2011-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-09-30	No
Was this plan covered by a fidelity bond	2011-09-30	Yes
Value of fidelity bond cover	2011-09-30	$500,000
If this is an individual account plan, was there a blackout period	2011-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-09-30	$0
Funding deficiency by the employer to the plan for this plan year	2011-09-30	$0
Minimum employer required contribution for this plan year	2011-09-30	$0
Amount contributed by the employer to the plan for this plan year	2011-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2011-09-30	No
Assets. Other investments not covered elsewhere at end of year	2011-09-30	$50,869
Assets. Other investments not covered elsewhere at beginning of year	2011-09-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-09-30	$15,876
Administrative expenses (other) incurred	2011-09-30	$8,900
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-09-30	No
Value of net income/loss	2011-09-30	$-431,773
Value of net assets at end of year (total assets less liabilities)	2011-09-30	$6,142,226
Value of net assets at beginning of year (total assets less liabilities)	2011-09-30	$6,573,999
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-09-30	No
Were any leases to which the plan was party in default or uncollectible	2011-09-30	No
Investment advisory and management fees	2011-09-30	$37,080
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-09-30	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-09-30	$6,573,999
Value of interest in pooled separate accounts at end of year	2011-09-30	$6,107,233
Value of interest in pooled separate accounts at beginning of year	2011-09-30	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-09-30	$-83,633
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-09-30	No
Was there a failure to transmit to the plan any participant contributions	2011-09-30	No
Has the plan failed to provide any benefit when due under the plan	2011-09-30	No
Contributions received in cash from employer	2011-09-30	$209,773
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-09-30	$501,119
Contract administrator fees	2011-09-30	$10,814
Did the plan have assets held for investment	2011-09-30	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	2011-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2011-09-30	Disclaimer
Accountancy firm name	2011-09-30	KERBER ECK & BRAECKEL LLP
Accountancy firm EIN	2011-09-30	430352985
2010 : IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2010 401k financial data
Funding deficiency by the employer to the plan for this plan year	2010-09-30	$0
Minimum employer required contribution for this plan year	2010-09-30	$0
Amount contributed by the employer to the plan for this plan year	2010-09-30	$0

Form 5500 Responses for IROQUOIS MEMORIAL HOSPITAL PENSION PLAN

2014: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	Yes
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan funding arrangement – Trust	Yes
2014-10-01	Plan benefit arrangement - Trust	Yes
2013: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan funding arrangement – Trust	Yes
2013-10-01	Plan benefit arrangement - Trust	Yes
2012: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan funding arrangement – Trust	Yes
2012-10-01	Plan benefit arrangement - Trust	Yes
2011: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan funding arrangement – Trust	Yes
2011-10-01	Plan benefit arrangement - Trust	Yes
2009: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan funding arrangement – Trust	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement - Trust	Yes
2008: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2008 form 5500 responses
2008-10-01	Type of plan entity	Single employer plan
2008-10-01	Submission has been amended	No
2008-10-01	This submission is the final filing	No
2008-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-10-01	Plan is a collectively bargained plan	No
2007: IROQUOIS MEMORIAL HOSPITAL PENSION PLAN 2007 form 5500 responses
2007-10-01	Type of plan entity	Single employer plan
2007-10-01	Submission has been amended	Yes
2007-10-01	This submission is the final filing	No
2007-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-10-01	Plan is a collectively bargained plan	No
2007-10-01	Plan funding arrangement – Insurance	Yes
2007-10-01	Plan funding arrangement – Trust	Yes
2007-10-01	Plan benefit arrangement – Insurance	Yes
2007-10-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

87243

Policy instance

Insurance contract or identification number	87243
Number of Individuals Covered	0
Insurance policy start date	2014-10-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $16,563
Total amount of fees paid to insurance company	USD $-175
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,622
Insurance broker organization code?	3
Amount paid for insurance broker fees	-175
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	BPC INC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

87243

Policy instance

Insurance contract or identification number	87243
Number of Individuals Covered	237
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $14,594
Total amount of fees paid to insurance company	USD $3,380
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,594
Insurance broker organization code?	3
Amount paid for insurance broker fees	3380
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	BPC INC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

87243

Policy instance

Insurance contract or identification number	87243
Number of Individuals Covered	259
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $16,133
Total amount of fees paid to insurance company	USD $4,353
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,679
Insurance broker organization code?	3
Amount paid for insurance broker fees	4353
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	BENEFIT PLANNING CONSULTANTS

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

87243

Policy instance

Insurance contract or identification number	87243
Number of Individuals Covered	291
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $16,317
Total amount of fees paid to insurance company	USD $75
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

87243

Policy instance

Insurance contract or identification number	87243
Number of Individuals Covered	306
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $17,776
Total amount of fees paid to insurance company	USD $195
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	IROQUOIS MEMORIAL HOSPITAL
Employer identification number (EIN):	370673512
NAIC Classification:	622000
NAIC Description:	Hospitals