401k Plan data: PERSON MEMORIAL HOSPITAL RETIREMENT PLAN plan

PERSON MEMORIAL HOSPITAL RETIREMENT PLAN 401k Plan overview

Plan Name	PERSON MEMORIAL HOSPITAL RETIREMENT PLAN
Plan identification number	002

PERSON MEMORIAL HOSPITAL RETIREMENT 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.
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

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

Company Name: PERSON MEMORIAL HOSPITAL

Employer identification number (EIN): 560543247

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PERSON MEMORIAL HOSPITAL RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2015-01-01 BILL FULLER 2015-07-13
002 2014-01-01 BILL FULLER 2015-03-26
002 2013-01-01 BILL FULLER 2014-11-21
002 2012-01-01 BILL FULLER 2014-11-21
002 2011-01-01 BILL FULLER
002 2009-01-01 JIM LEIS MARY DRUMWRIGHT 2010-10-11
002 2009-01-01 MARY DRUMWRIGHT 2010-10-11

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2015-01-01	BILL FULLER	2015-07-13
002	2014-01-01	BILL FULLER	2015-03-26
002	2013-01-01	BILL FULLER	2014-11-21
002	2012-01-01	BILL FULLER	2014-11-21
002	2011-01-01	BILL FULLER
002	2009-01-01	JIM LEIS		MARY DRUMWRIGHT	2010-10-11
002	2009-01-01			MARY DRUMWRIGHT	2010-10-11

Plan Statistics for PERSON MEMORIAL HOSPITAL RETIREMENT PLAN

401k plan membership statisitcs for PERSON MEMORIAL HOSPITAL RETIREMENT PLAN

Measure Date Value
2011: PERSON MEMORIAL HOSPITAL RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 587
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 0
Number of retired or separated participants receiving benefits 2011-01-01 3
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 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 16
Number of participants with account balances 2011-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: PERSON MEMORIAL HOSPITAL RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 649
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 434
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 167
Total of all active and inactive participants 2009-01-01 601
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 601
Number of participants with account balances 2009-01-01 477
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: PERSON MEMORIAL HOSPITAL RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	587
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	0
Number of retired or separated participants receiving benefits	2011-01-01	3
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	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	16
Number of participants with account balances	2011-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: PERSON MEMORIAL HOSPITAL RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	649
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	434
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	167
Total of all active and inactive participants	2009-01-01	601
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	601
Number of participants with account balances	2009-01-01	477
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on PERSON MEMORIAL HOSPITAL RETIREMENT PLAN

Measure	Date	Value
2011 : PERSON MEMORIAL HOSPITAL RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$284,052
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$8,521,913
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$8,484,280
Expenses. Certain deemed distributions of participant loans	2011-12-31	$23,485
Value of total corrective distributions	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$365,698
Value of total assets at end of year	2011-12-31	$31,105
Value of total assets at beginning of year	2011-12-31	$8,268,966
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$14,148
Total interest from all sources	2011-12-31	$101,441
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$271,562
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$98,395
Income. Received or receivable in cash from other sources (including rollovers)	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	$-8,237,861
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$31,105
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$8,268,966
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$21,515
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$4,877,180
Interest on participant loans	2011-12-31	$2,920
Interest earned on other investments	2011-12-31	$98,521
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$9,590
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$3,293,391
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-183,087
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	$94,136
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$8,484,280
Contract administrator fees	2011-12-31	$14,148
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2011-12-31	410746749
2010 : PERSON MEMORIAL HOSPITAL RETIREMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$1,337,113
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$994,622
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$970,402
Expenses. Certain deemed distributions of participant loans	2010-12-31	$11,757
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$575,397
Value of total assets at end of year	2010-12-31	$8,268,966
Value of total assets at beginning of year	2010-12-31	$7,926,475
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$12,463
Total interest from all sources	2010-12-31	$114,963
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$59
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	$59
Administrative expenses professional fees incurred	2010-12-31	$12,463
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$418,304
Participant contributions at end of year	2010-12-31	$98,395
Participant contributions at beginning of year	2010-12-31	$50,128
Participant contributions at beginning of year	2010-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$41,929
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	$342,491
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$8,268,966
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$7,926,475
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$4,877,180
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$4,572,823
Interest on participant loans	2010-12-31	$3,249
Interest earned on other investments	2010-12-31	$111,714
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$3,293,391
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$3,303,524
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$646,694
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	$115,164
Employer contributions (assets) at beginning of year	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$970,402
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	LARSON ALLEN LLP
Accountancy firm EIN	2010-12-31	410746749
2009 : PERSON MEMORIAL HOSPITAL RETIREMENT 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 PERSON MEMORIAL HOSPITAL RETIREMENT PLAN

2011: PERSON MEMORIAL HOSPITAL RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: PERSON MEMORIAL HOSPITAL RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

61701

Policy instance

Insurance contract or identification number	61701
Number of Individuals Covered	350
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,846
Total amount of fees paid to insurance company	USD $0
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

FA068344

Policy instance

Insurance contract or identification number	FA068344
Number of Individuals Covered	16
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

61701

Policy instance

Insurance contract or identification number	61701
Number of Individuals Covered	457
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $7,384
Total amount of fees paid to insurance company	USD $0
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	1
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

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

FA068344

Policy instance

Insurance contract or identification number	FA068344
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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?	Yes
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:	PERSON MEMORIAL HOSPITAL
Employer identification number (EIN):	560543247
NAIC Classification:	622000
NAIC Description:	Hospitals