401k Plan data: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN plan

COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 401k Plan overview

Plan Name	COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN
Plan identification number	001

COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) 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)(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.

401k Sponsoring company profile

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

Company Name: COMMUNITY MEMORIAL HOSPITAL, INC.

Employer identification number (EIN): 390848401

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about COMMUNITY MEMORIAL HOSPITAL, INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1950-02-07

Company Identification Number: 74403

More information about COMMUNITY MEMORIAL HOSPITAL, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 MICHELE MILLER-CAMPBELL
001 2014-01-01 MICHELE MILLER-CAMPBELL
001 2013-01-01 MICHELE MILLER-CAMPBELL
001 2012-01-01 MICHELE MILLER-CAMPBELL
001 2011-01-01 MICHELE MILLER-CAMPBELL
001 2009-01-01 LISA M. KRAUSE

Plan id#	Filing Submission Date	Name of Administrator
001	2015-01-01	MICHELE MILLER-CAMPBELL
001	2014-01-01	MICHELE MILLER-CAMPBELL
001	2013-01-01	MICHELE MILLER-CAMPBELL
001	2012-01-01	MICHELE MILLER-CAMPBELL
001	2011-01-01	MICHELE MILLER-CAMPBELL
001	2009-01-01	LISA M. KRAUSE

Plan Statistics for COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN

401k plan membership statisitcs for COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN

Measure Date Value
2015: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 219
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 399
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 220
Total of all active and inactive participants 2014-01-01 220
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 220
Number of participants with account balances 2014-01-01 220
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 21
2013: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 368
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 350
Number of retired or separated participants receiving benefits 2013-01-01 4
Number of other retired or separated participants entitled to future benefits 2013-01-01 46
Total of all active and inactive participants 2013-01-01 400
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 400
Number of participants with account balances 2013-01-01 293
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 2
2012: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 416
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 367
Number of retired or separated participants receiving benefits 2012-01-01 5
Number of other retired or separated participants entitled to future benefits 2012-01-01 40
Total of all active and inactive participants 2012-01-01 412
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 412
Number of participants with account balances 2012-01-01 279
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 3
2011: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 418
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 378
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 40
Total of all active and inactive participants 2011-01-01 421
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 421
Number of participants with account balances 2011-01-01 282
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 11
2009: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 391
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 377
Number of retired or separated participants receiving benefits 2009-01-01 2
Number of other retired or separated participants entitled to future benefits 2009-01-01 24
Total of all active and inactive participants 2009-01-01 403
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 403
Number of participants with account balances 2009-01-01 279
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 7

Measure	Date	Value
2015: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	219
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	399
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	220
Total of all active and inactive participants	2014-01-01	220
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	220
Number of participants with account balances	2014-01-01	220
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	21
2013: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	368
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	350
Number of retired or separated participants receiving benefits	2013-01-01	4
Number of other retired or separated participants entitled to future benefits	2013-01-01	46
Total of all active and inactive participants	2013-01-01	400
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	400
Number of participants with account balances	2013-01-01	293
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2012: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	416
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	367
Number of retired or separated participants receiving benefits	2012-01-01	5
Number of other retired or separated participants entitled to future benefits	2012-01-01	40
Total of all active and inactive participants	2012-01-01	412
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	412
Number of participants with account balances	2012-01-01	279
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	3
2011: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	418
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	378
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	40
Total of all active and inactive participants	2011-01-01	421
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	421
Number of participants with account balances	2011-01-01	282
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	11
2009: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	391
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	377
Number of retired or separated participants receiving benefits	2009-01-01	2
Number of other retired or separated participants entitled to future benefits	2009-01-01	24
Total of all active and inactive participants	2009-01-01	403
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	403
Number of participants with account balances	2009-01-01	279
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	7

Financial Data on COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN

Measure	Date	Value
2015 : COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-09-30	$5,789
Total income from all sources (including contributions)	2015-09-30	$-25,609
Total loss/gain on sale of assets	2015-09-30	$0
Total of all expenses incurred	2015-09-30	$9,906,024
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-09-30	$9,876,913
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-09-30	$0
Value of total assets at end of year	2015-09-30	$0
Value of total assets at beginning of year	2015-09-30	$9,937,422
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-09-30	$29,111
Total interest from all sources	2015-09-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-09-30	$2,599
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-09-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2015-09-30	$0
Total dividends received from registered investment company shares (eg mutual funds)	2015-09-30	$2,599
Administrative expenses professional fees incurred	2015-09-30	$23,301
Was this plan covered by a fidelity bond	2015-09-30	Yes
Value of fidelity bond cover	2015-09-30	$500,000
If this is an individual account plan, was there a blackout period	2015-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2015-09-30	No
Participant contributions at end of year	2015-09-30	$0
Participant contributions at beginning of year	2015-09-30	$103,664
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-09-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-09-30	$5,789
Total non interest bearing cash at end of year	2015-09-30	$0
Total non interest bearing cash at beginning of year	2015-09-30	$5,789
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-09-30	No
Value of net income/loss	2015-09-30	$-9,931,633
Value of net assets at end of year (total assets less liabilities)	2015-09-30	$0
Value of net assets at beginning of year (total assets less liabilities)	2015-09-30	$9,931,633
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-09-30	No
Were any leases to which the plan was party in default or uncollectible	2015-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-09-30	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-09-30	$9,827,969
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-09-30	$-28,208
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-09-30	No
Was there a failure to transmit to the plan any participant contributions	2015-09-30	No
Has the plan failed to provide any benefit when due under the plan	2015-09-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-09-30	$9,876,913
Contract administrator fees	2015-09-30	$5,810
Did the plan have assets held for investment	2015-09-30	No
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	2015-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-09-30	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2015-09-30	Disclaimer
Accountancy firm name	2015-09-30	HERMANS & ASSOCIATES, CPA'S, S.C.
Accountancy firm EIN	2015-09-30	391421794
2014 : COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$5,789
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$2,181
Total income from all sources (including contributions)	2014-12-31	$1,765,707
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$6,074,537
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$6,003,835
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,053,757
Value of total assets at end of year	2014-12-31	$9,937,422
Value of total assets at beginning of year	2014-12-31	$14,242,644
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$70,702
Total interest from all sources	2014-12-31	$7,077
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$368,992
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2014-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$368,992
Administrative expenses professional fees incurred	2014-12-31	$14,460
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$710,883
Participant contributions at end of year	2014-12-31	$103,664
Participant contributions at beginning of year	2014-12-31	$166,649
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$59,168
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$5,789
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$2,181
Total non interest bearing cash at end of year	2014-12-31	$5,789
Total non interest bearing cash at beginning of year	2014-12-31	$3,147
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-4,308,830
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$9,931,633
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$14,240,463
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Investment advisory and management fees	2014-12-31	$49,130
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$9,827,969
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$14,070,616
Interest on participant loans	2014-12-31	$7,077
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$335,881
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$283,706
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$2,232
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$6,003,835
Contract administrator fees	2014-12-31	$7,112
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	HERMANS & ASSOCIATES, CPA'S, S.C.
Accountancy firm EIN	2014-12-31	391421794
2013 : COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$2,181
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$1,842
Total income from all sources (including contributions)	2013-12-31	$3,606,584
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$2,003,196
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,937,262
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$1,430,662
Value of total assets at end of year	2013-12-31	$14,242,644
Value of total assets at beginning of year	2013-12-31	$12,638,917
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$65,934
Total interest from all sources	2013-12-31	$8,229
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$367,833
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$367,833
Administrative expenses professional fees incurred	2013-12-31	$12,394
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$767,478
Participant contributions at end of year	2013-12-31	$166,649
Participant contributions at beginning of year	2013-12-31	$173,078
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$368,600
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$2,181
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$1,842
Total non interest bearing cash at end of year	2013-12-31	$3,147
Total non interest bearing cash at beginning of year	2013-12-31	$1,782
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$1,603,388
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$14,240,463
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$12,637,075
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Investment advisory and management fees	2013-12-31	$45,975
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$14,070,616
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$12,461,124
Interest on participant loans	2013-12-31	$8,229
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$1,799,860
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$294,584
Employer contributions (assets) at end of year	2013-12-31	$2,232
Employer contributions (assets) at beginning of year	2013-12-31	$2,933
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,937,262
Contract administrator fees	2013-12-31	$7,565
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	HERMANS & ASSOCIATES, CPA'S, S.C.
Accountancy firm EIN	2013-12-31	391421794
2012 : COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$1,842
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$2,223
Total income from all sources (including contributions)	2012-12-31	$2,809,651
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$1,225,895
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$1,160,064
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$1,092,400
Value of total assets at end of year	2012-12-31	$12,638,917
Value of total assets at beginning of year	2012-12-31	$11,055,542
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$65,831
Total interest from all sources	2012-12-31	$10,171
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$434,272
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	$434,272
Administrative expenses professional fees incurred	2012-12-31	$15,134
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	$764,502
Participant contributions at end of year	2012-12-31	$173,078
Participant contributions at beginning of year	2012-12-31	$186,618
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$31,363
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$1,842
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$2,223
Administrative expenses (other) incurred	2012-12-31	$4,586
Total non interest bearing cash at end of year	2012-12-31	$1,782
Total non interest bearing cash at beginning of year	2012-12-31	$40,873
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	$1,583,756
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$12,637,075
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$11,053,319
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
Investment advisory and management fees	2012-12-31	$46,111
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$12,461,124
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$10,826,510
Interest on participant loans	2012-12-31	$10,171
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$1,272,808
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
Contributions received in cash from employer	2012-12-31	$296,535
Employer contributions (assets) at end of year	2012-12-31	$2,933
Employer contributions (assets) at beginning of year	2012-12-31	$1,541
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$1,160,064
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	HERMANS & ASSOCIATES, CPA'S, S.C.
Accountancy firm EIN	2012-12-31	391421794
2011 : COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) 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	$2,223
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$549
Total income from all sources (including contributions)	2011-12-31	$788,710
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$1,951,621
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,890,790
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$1,240,215
Value of total assets at end of year	2011-12-31	$11,055,542
Value of total assets at beginning of year	2011-12-31	$12,216,779
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$60,831
Total interest from all sources	2011-12-31	$8,311
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$299,708
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	$299,708
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	$831,020
Participant contributions at end of year	2011-12-31	$186,618
Participant contributions at beginning of year	2011-12-31	$157,160
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$87,394
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$2,223
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$549
Administrative expenses (other) incurred	2011-12-31	$14,985
Total non interest bearing cash at end of year	2011-12-31	$40,873
Total non interest bearing cash at beginning of year	2011-12-31	$541
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	$-1,162,911
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$11,053,319
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$12,216,230
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
Investment advisory and management fees	2011-12-31	$45,846
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$10,826,510
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$12,058,463
Interest on participant loans	2011-12-31	$8,311
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-759,524
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	$321,801
Employer contributions (assets) at end of year	2011-12-31	$1,541
Employer contributions (assets) at beginning of year	2011-12-31	$615
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,890,790
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	HERMANS & ASSOCIATES, CPA'S, S.C.
Accountancy firm EIN	2011-12-31	391421794
2010 : COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) 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	$549
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$465
Total income from all sources (including contributions)	2010-12-31	$2,509,062
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$243,095
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$185,486
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$960,397
Value of total assets at end of year	2010-12-31	$12,216,779
Value of total assets at beginning of year	2010-12-31	$9,950,728
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$57,609
Total interest from all sources	2010-12-31	$7,674
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$234,623
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	$234,623
Administrative expenses professional fees incurred	2010-12-31	$3,900
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	$853,951
Participant contributions at end of year	2010-12-31	$157,160
Participant contributions at beginning of year	2010-12-31	$128,882
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$37,242
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$549
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$465
Administrative expenses (other) incurred	2010-12-31	$11,214
Total non interest bearing cash at end of year	2010-12-31	$541
Total non interest bearing cash at beginning of year	2010-12-31	$466
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	$2,265,967
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$12,216,230
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$9,950,263
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
Investment advisory and management fees	2010-12-31	$42,495
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$12,058,463
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$9,821,380
Interest on participant loans	2010-12-31	$7,674
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$1,306,368
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	$69,204
Employer contributions (assets) at end of year	2010-12-31	$615
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	$185,486
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	HERMANS & ASSOCIATES, CPA'S S.C.
Accountancy firm EIN	2010-12-31	391421794
2009 : COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) 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 COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN

2015: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	Yes
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) 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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: COMMUNITY MEMORIAL HOSPITAL, INC. 403(B) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	COMMUNITY MEMORIAL HOSPITAL, INC.
Employer identification number (EIN):	390848401
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1950-02-07
Company Identification Number:	74403