401k Plan data: IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN plan

IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN
Plan identification number	501

IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: IU HEALTH WHITE MEMORIAL HOSPITAL, INC.

Employer identification number (EIN): 273532963

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2013-01-01 JEFFREY ZEH
501 2012-01-01 STEPHANIE LONG
501 2011-01-01 STEPHANIE LONG

Plan id#	Filing Submission Date	Name of Administrator
501	2013-01-01	JEFFREY ZEH
501	2012-01-01	STEPHANIE LONG
501	2011-01-01	STEPHANIE LONG

Plan Statistics for IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2013: IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 176
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 184
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 5
Total of all active and inactive participants 2013-01-01 189
Total participants 2013-01-01 189
2012: IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 145
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 1
Total of all active and inactive participants 2012-01-01 147
Total participants 2012-01-01 147
2011: IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 190
Number of retired or separated participants receiving benefits 2011-01-01 4
Number of other retired or separated participants entitled to future benefits 2011-01-01 6
Total of all active and inactive participants 2011-01-01 200
Total participants 2011-01-01 200

Measure	Date	Value
2013: IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	176
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	184
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	5
Total of all active and inactive participants	2013-01-01	189
Total participants	2013-01-01	189
2012: IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	145
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	1
Total of all active and inactive participants	2012-01-01	147
Total participants	2012-01-01	147
2011: IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	190
Number of retired or separated participants receiving benefits	2011-01-01	4
Number of other retired or separated participants entitled to future benefits	2011-01-01	6
Total of all active and inactive participants	2011-01-01	200
Total participants	2011-01-01	200

Form 5500 Responses for IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN

2013: IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	This submission is the final filing	Yes
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 – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
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 – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: IU HEALTH WHITE MEMORIAL HOSPITAL, INC. EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Submission has been amended	No
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 – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	IU HEALTH WHITE MEMORIAL HOSPITAL, INC.
Employer identification number (EIN):	273532963
NAIC Classification:	622000
NAIC Description:	Hospitals