401k Plan data: NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN plan

NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN 401k Plan overview

Plan Name	NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN
Plan identification number	002

NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY 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. Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations. Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM has sponsored the creation of one or more 401k plans.

Company Name: NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM

Employer identification number (EIN): 382445613

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM

Jurisdiction of Incorporation: Michigan Secretary of State

Incorporation Date: 0000-00-00

Company Identification Number: 711499

Legal Registered Office Address: 416 CONNABLE AVE PETOSKEY

United States of America (USA)
49770

More information about NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2011-01-01 CHRISTINE VANSLEMBROUCK EUGENE KAMINSKI 2014-07-21
002 2010-01-01 CHRISTINE VANSLEMBROUCK EUGENE KAMINSKI 2014-07-21
002 2009-01-01 CHRISTINE VANSLEMBROUCK EUGENE KAMINSKI 2014-07-21

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2011-01-01	CHRISTINE VANSLEMBROUCK	EUGENE KAMINSKI	2014-07-21
002	2010-01-01	CHRISTINE VANSLEMBROUCK	EUGENE KAMINSKI	2014-07-21
002	2009-01-01	CHRISTINE VANSLEMBROUCK	EUGENE KAMINSKI	2014-07-21

Plan Statistics for NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN

401k plan membership statisitcs for NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN

Measure Date Value
2011: NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,859
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,786
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 73
Total of all active and inactive participants 2011-01-01 1,859
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 1,859
Number of participants with account balances 2011-01-01 826
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 933
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1,809
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 37
Total of all active and inactive participants 2010-01-01 1,846
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 1,846
Number of participants with account balances 2010-01-01 913
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 922
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 873
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 59
Total of all active and inactive participants 2009-01-01 932
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 933
Number of participants with account balances 2009-01-01 882
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: NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,859
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,786
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	73
Total of all active and inactive participants	2011-01-01	1,859
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	1,859
Number of participants with account balances	2011-01-01	826
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	933
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,809
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	37
Total of all active and inactive participants	2010-01-01	1,846
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	1,846
Number of participants with account balances	2010-01-01	913
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	922
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	873
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	59
Total of all active and inactive participants	2009-01-01	932
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	933
Number of participants with account balances	2009-01-01	882
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN

Measure	Date	Value
2011 : NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets to this plan	2011-12-31	$1,511,719
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	$3,157,700
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$988,026
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$960,997
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$3,402,443
Value of total assets at end of year	2011-12-31	$18,488,067
Value of total assets at beginning of year	2011-12-31	$14,806,674
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$27,029
Total interest from all sources	2011-12-31	$70,737
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$279,198
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	$279,198
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
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
Contributions received from participants	2011-12-31	$3,308,211
Participant contributions at end of year	2011-12-31	$266,478
Participant contributions at beginning of year	2011-12-31	$198,082
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	$2,169,674
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$18,488,067
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$14,806,674
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	$15,368,580
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$12,811,318
Interest on participant loans	2011-12-31	$8,839
Interest earned on other investments	2011-12-31	$61,898
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$2,853,009
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$1,797,274
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-594,678
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	$94,232
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$960,997
Contract administrator fees	2011-12-31	$27,029
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	PLANTE & MORAN PLLC
Accountancy firm EIN	2011-12-31	381357951
2010 : NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$836,147
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	$5,221,412
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$1,041,056
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,021,691
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$3,680,832
Value of total assets at end of year	2010-12-31	$14,806,674
Value of total assets at beginning of year	2010-12-31	$9,790,171
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$19,365
Total interest from all sources	2010-12-31	$57,890
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$204,303
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	$204,303
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
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
Contributions received from participants	2010-12-31	$3,577,975
Participant contributions at end of year	2010-12-31	$198,082
Participant contributions at beginning of year	2010-12-31	$18,158
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	$4,180,356
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$14,806,674
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$9,790,171
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	$12,811,318
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$8,035,114
Interest on participant loans	2010-12-31	$2,554
Interest earned on other investments	2010-12-31	$55,336
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$1,797,274
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$1,736,899
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$1,278,387
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	$102,857
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,021,691
Contract administrator fees	2010-12-31	$19,365
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	PLANTE & MORAN PLLC
Accountancy firm EIN	2010-12-31	381357951
2009 : NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN 2009 401k financial data
Total unrealized appreciation/depreciation of assets	2009-12-31	$0
Total transfer of assets to this plan	2009-12-31	$5,220,657
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2009-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2009-12-31	$0
Total income from all sources (including contributions)	2009-12-31	$5,723,206
Total loss/gain on sale of assets	2009-12-31	$0
Total of all expenses incurred	2009-12-31	$1,153,692
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2009-12-31	$1,144,706
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2009-12-31	$4,203,224
Value of total assets at end of year	2009-12-31	$9,790,171
Value of total assets at beginning of year	2009-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2009-12-31	$8,986
Total interest from all sources	2009-12-31	$34,838
Total dividends received (eg from common stock, registered investment company shares)	2009-12-31	$144,223
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2009-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2009-12-31	$144,223
Was this plan covered by a fidelity bond	2009-12-31	Yes
Value of fidelity bond cover	2009-12-31	$500,000
If this is an individual account plan, was there a blackout period	2009-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2009-12-31	No
Contributions received from participants	2009-12-31	$3,756,168
Participant contributions at end of year	2009-12-31	$18,158
Participant contributions at beginning of year	2009-12-31	$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	2009-12-31	No
Value of net income/loss	2009-12-31	$4,569,514
Value of net assets at end of year (total assets less liabilities)	2009-12-31	$9,790,171
Value of net assets at beginning of year (total assets less liabilities)	2009-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2009-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2009-12-31	No
Were any leases to which the plan was party in default or uncollectible	2009-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2009-12-31	$8,035,114
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2009-12-31	$0
Interest on participant loans	2009-12-31	$237
Interest earned on other investments	2009-12-31	$34,601
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2009-12-31	$1,736,899
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2009-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2009-12-31	$1,340,921
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2009-12-31	No
Was there a failure to transmit to the plan any participant contributions	2009-12-31	No
Has the plan failed to provide any benefit when due under the plan	2009-12-31	No
Contributions received in cash from employer	2009-12-31	$447,056
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2009-12-31	$1,144,706
Contract administrator fees	2009-12-31	$8,986
Did the plan have assets held for investment	2009-12-31	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	2009-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2009-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2009-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2009-12-31	Disclaimer
Accountancy firm name	2009-12-31	PLANTE & MORAN PLLC
Accountancy firm EIN	2009-12-31	381357951

Form 5500 Responses for NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN

2011: NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
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 – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
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: NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM TAX DEFERRED ANNUITY SAVINGS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
2009-01-01	Submission has been amended	No
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

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Company Name:	NORTHERN MICHIGAN REGIONAL HEALTH SYSTEM
Employer identification number (EIN):	382445613
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Michigan Secretary of State
Incorporation Date:	0000-00-00
Company Identification Number:	711499
Legal Registered Office Address:	416 CONNABLE AVE PETOSKEY United States of America (USA) 49770