401k Plan data: NEWTON MEMORIAL HOSPITAL TAX DEFERRED ANNUITY PLAN plan

NEWTON MEMORIAL HOSPITAL TAX DEFERRED ANNUITY PLAN 401k Plan overview

Plan Name	NEWTON MEMORIAL HOSPITAL TAX DEFERRED ANNUITY PLAN
Plan identification number	001

NEWTON MEMORIAL HOSPITAL TAX DEFERRED ANNUITY 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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

ATLANTIC HEALTH SYSTEM has sponsored the creation of one or more 401k plans.

Company Name: ATLANTIC HEALTH SYSTEM

Employer identification number (EIN): 521958352

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NEWTON MEMORIAL HOSPITAL TAX DEFERRED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 LYNN TURNER 2014-05-14
001 2012-01-01 CONSTANCE WERNER HOPKINS LYNN TURNER 2013-10-15
001 2011-01-01 LYNN TURNER 2012-10-10
001 2010-01-01 LYNN TURNER 2011-10-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2013-01-01	LYNN TURNER	2014-05-14
001	2012-01-01	CONSTANCE WERNER HOPKINS		LYNN TURNER	2013-10-15
001	2011-01-01	LYNN TURNER	2012-10-10
001	2010-01-01	LYNN TURNER	2011-10-14

Plan Statistics for NEWTON MEMORIAL HOSPITAL TAX DEFERRED ANNUITY PLAN

401k plan membership statisitcs for NEWTON MEMORIAL HOSPITAL TAX DEFERRED ANNUITY PLAN

Measure Date Value
2012: NEWTON MEMORIAL HOSPITAL TAX DEFERRED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,265
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,509
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 32
Total of all active and inactive participants 2012-01-01 1,542
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 2
Total participants 2012-01-01 1,544
Number of participants with account balances 2012-01-01 845
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 69

Measure	Date	Value
2012: NEWTON MEMORIAL HOSPITAL TAX DEFERRED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,265
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,509
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	32
Total of all active and inactive participants	2012-01-01	1,542
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	2
Total participants	2012-01-01	1,544
Number of participants with account balances	2012-01-01	845
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	69

Financial Data on NEWTON MEMORIAL HOSPITAL TAX DEFERRED ANNUITY PLAN

Measure	Date	Value
2012 : NEWTON MEMORIAL HOSPITAL TAX DEFERRED ANNUITY PLAN 2012 401k financial data
Total transfer of assets to this plan	2012-12-31	$10,603,296
Total income from all sources (including contributions)	2012-12-31	$3,639,687
Total of all expenses incurred	2012-12-31	$1,964,624
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$1,896,798
Expenses. Certain deemed distributions of participant loans	2012-12-31	$58,980
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$1,977,674
Value of total assets at end of year	2012-12-31	$26,275,353
Value of total assets at beginning of year	2012-12-31	$13,996,994
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$8,846
Total interest from all sources	2012-12-31	$29,509
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$233,233
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	$233,233
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$1,803,124
Participant contributions at end of year	2012-12-31	$499,890
Participant contributions at beginning of year	2012-12-31	$315,089
Participant contributions at end of year	2012-12-31	$97,100
Participant contributions at beginning of year	2012-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$174,550
Administrative expenses (other) incurred	2012-12-31	$8,846
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$1,675,063
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$26,275,353
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$13,996,994
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$16,057,436
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$8,320,563
Interest on participant loans	2012-12-31	$15,448
Interest earned on other investments	2012-12-31	$14,061
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$9,620,927
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$5,361,342
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$1,399,271
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$1,896,798
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	WISS & CO. LLP
Accountancy firm EIN	2012-12-31	221732349

Form 5500 Responses for NEWTON MEMORIAL HOSPITAL TAX DEFERRED ANNUITY PLAN

2012: NEWTON MEMORIAL HOSPITAL TAX DEFERRED ANNUITY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
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

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

MR 60288

Policy instance

Insurance contract or identification number	MR 60288
Number of Individuals Covered	1559
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
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
Contracts With Unallocated Funds Deposit Administration	0
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

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

914206

Policy instance

Insurance contract or identification number	914206
Number of Individuals Covered	31
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $87
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
Contracts With Unallocated Funds Deposit Administration	0
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 $87
Insurance broker name	METLIFE SECURITIES INC.

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

1071079

Policy instance

Insurance contract or identification number	1071079
Number of Individuals Covered	144
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
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
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ATLANTIC HEALTH SYSTEM
Employer identification number (EIN):	521958352
NAIC Classification:	622000
NAIC Description:	Hospitals