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

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

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

WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

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

Company Name: WILD ROSE COMMUNITY MEMORIAL HOSPITAL INC.

Employer identification number (EIN): 396089134

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-07-01 KAREN GARVEY
001 2012-07-01 DONALD CAVES
001 2011-07-01 DON CAVES
001 2010-07-01 KAREN M. WEST
001 2009-07-01 KAREN M. WEST
001 2009-07-01 KAREN M. WEST

Plan id#	Filing Submission Date	Name of Administrator
001	2013-07-01	KAREN GARVEY
001	2012-07-01	DONALD CAVES
001	2011-07-01	DON CAVES
001	2010-07-01	KAREN M. WEST
001	2009-07-01	KAREN M. WEST
001	2009-07-01	KAREN M. WEST

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

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

Measure Date Value
2013: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 194
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 149
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 42
Total of all active and inactive participants 2013-07-01 191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-07-01 0
Total participants 2013-07-01 191
Number of participants with account balances 2013-07-01 145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-07-01 0
2012: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 183
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 159
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 35
Total of all active and inactive participants 2012-07-01 194
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 0
Total participants 2012-07-01 194
Number of participants with account balances 2012-07-01 140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-01 0
2011: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 184
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 160
Number of retired or separated participants receiving benefits 2011-07-01 0
Number of other retired or separated participants entitled to future benefits 2011-07-01 22
Total of all active and inactive participants 2011-07-01 182
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 1
Total participants 2011-07-01 183
Number of participants with account balances 2011-07-01 141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 0
2010: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2010 401k membership
Total participants, beginning-of-year 2010-07-01 179
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 159
Number of retired or separated participants receiving benefits 2010-07-01 0
Number of other retired or separated participants entitled to future benefits 2010-07-01 23
Total of all active and inactive participants 2010-07-01 182
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-07-01 2
Total participants 2010-07-01 184
Number of participants with account balances 2010-07-01 128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-07-01 0
2009: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 122
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 124
Number of retired or separated participants receiving benefits 2009-07-01 0
Number of other retired or separated participants entitled to future benefits 2009-07-01 0
Total of all active and inactive participants 2009-07-01 124
Total participants 2009-07-01 124
Number of participants with account balances 2009-07-01 123

Measure	Date	Value
2013: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	194
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	149
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	42
Total of all active and inactive participants	2013-07-01	191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-07-01	0
Total participants	2013-07-01	191
Number of participants with account balances	2013-07-01	145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-07-01	0
2012: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	183
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	159
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	35
Total of all active and inactive participants	2012-07-01	194
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	0
Total participants	2012-07-01	194
Number of participants with account balances	2012-07-01	140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-01	0
2011: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	184
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	160
Number of retired or separated participants receiving benefits	2011-07-01	0
Number of other retired or separated participants entitled to future benefits	2011-07-01	22
Total of all active and inactive participants	2011-07-01	182
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	1
Total participants	2011-07-01	183
Number of participants with account balances	2011-07-01	141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	0
2010: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2010 401k membership
Total participants, beginning-of-year	2010-07-01	179
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	159
Number of retired or separated participants receiving benefits	2010-07-01	0
Number of other retired or separated participants entitled to future benefits	2010-07-01	23
Total of all active and inactive participants	2010-07-01	182
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-07-01	2
Total participants	2010-07-01	184
Number of participants with account balances	2010-07-01	128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-07-01	0
2009: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	122
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	124
Number of retired or separated participants receiving benefits	2009-07-01	0
Number of other retired or separated participants entitled to future benefits	2009-07-01	0
Total of all active and inactive participants	2009-07-01	124
Total participants	2009-07-01	124
Number of participants with account balances	2009-07-01	123

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

Measure	Date	Value
2014 : WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$0
Total income from all sources (including contributions)	2014-06-30	$748,268
Total loss/gain on sale of assets	2014-06-30	$0
Total of all expenses incurred	2014-06-30	$95,546
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-06-30	$91,188
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-06-30	$367,489
Value of total assets at end of year	2014-06-30	$3,452,225
Value of total assets at beginning of year	2014-06-30	$2,799,503
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-06-30	$4,358
Total interest from all sources	2014-06-30	$27,974
Total dividends received (eg from common stock, registered investment company shares)	2014-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-06-30	No
Was this plan covered by a fidelity bond	2014-06-30	Yes
Value of fidelity bond cover	2014-06-30	$500,000
If this is an individual account plan, was there a blackout period	2014-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2014-06-30	No
Contributions received from participants	2014-06-30	$161,208
Participant contributions at end of year	2014-06-30	$6,584
Participant contributions at beginning of year	2014-06-30	$5,594
Income. Received or receivable in cash from other sources (including rollovers)	2014-06-30	$9,204
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-06-30	No
Value of net income/loss	2014-06-30	$652,722
Value of net assets at end of year (total assets less liabilities)	2014-06-30	$3,452,225
Value of net assets at beginning of year (total assets less liabilities)	2014-06-30	$2,799,503
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-06-30	No
Were any leases to which the plan was party in default or uncollectible	2014-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-06-30	$2,482,261
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-06-30	$1,896,476
Interest earned on other investments	2014-06-30	$27,974
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-06-30	$954,825
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-06-30	$892,668
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-06-30	$352,805
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-06-30	No
Was there a failure to transmit to the plan any participant contributions	2014-06-30	No
Has the plan failed to provide any benefit when due under the plan	2014-06-30	No
Contributions received in cash from employer	2014-06-30	$197,077
Employer contributions (assets) at end of year	2014-06-30	$8,555
Employer contributions (assets) at beginning of year	2014-06-30	$4,765
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-06-30	$91,188
Contract administrator fees	2014-06-30	$4,358
Did the plan have assets held for investment	2014-06-30	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	2014-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2014-06-30	Disclaimer
Accountancy firm name	2014-06-30	WIPFLI, LLP
Accountancy firm EIN	2014-06-30	390758449
2013 : WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$0
Total income from all sources (including contributions)	2013-06-30	$535,861
Total loss/gain on sale of assets	2013-06-30	$0
Total of all expenses incurred	2013-06-30	$145,210
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-06-30	$140,542
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-06-30	$282,190
Value of total assets at end of year	2013-06-30	$2,799,503
Value of total assets at beginning of year	2013-06-30	$2,408,852
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-06-30	$4,668
Total interest from all sources	2013-06-30	$25,154
Total dividends received (eg from common stock, registered investment company shares)	2013-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-06-30	No
Was this plan covered by a fidelity bond	2013-06-30	Yes
Value of fidelity bond cover	2013-06-30	$200,000
If this is an individual account plan, was there a blackout period	2013-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2013-06-30	No
Contributions received from participants	2013-06-30	$152,122
Participant contributions at end of year	2013-06-30	$5,594
Participant contributions at beginning of year	2013-06-30	$5,669
Income. Received or receivable in cash from other sources (including rollovers)	2013-06-30	$4,981
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-06-30	No
Value of net income/loss	2013-06-30	$390,651
Value of net assets at end of year (total assets less liabilities)	2013-06-30	$2,799,503
Value of net assets at beginning of year (total assets less liabilities)	2013-06-30	$2,408,852
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-06-30	No
Were any leases to which the plan was party in default or uncollectible	2013-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-06-30	$1,896,476
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-06-30	$1,626,299
Interest earned on other investments	2013-06-30	$25,154
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-06-30	$892,668
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-06-30	$772,262
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-06-30	$228,517
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-06-30	No
Was there a failure to transmit to the plan any participant contributions	2013-06-30	No
Has the plan failed to provide any benefit when due under the plan	2013-06-30	No
Contributions received in cash from employer	2013-06-30	$125,087
Employer contributions (assets) at end of year	2013-06-30	$4,765
Employer contributions (assets) at beginning of year	2013-06-30	$4,622
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-06-30	$140,542
Contract administrator fees	2013-06-30	$4,668
Did the plan have assets held for investment	2013-06-30	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	2013-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2013-06-30	Disclaimer
Accountancy firm name	2013-06-30	WIPFLI, LLP
Accountancy firm EIN	2013-06-30	390758449
2012 : WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$0
Total income from all sources (including contributions)	2012-06-30	$294,629
Total loss/gain on sale of assets	2012-06-30	$0
Total of all expenses incurred	2012-06-30	$67,792
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$63,996
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$290,462
Value of total assets at end of year	2012-06-30	$2,408,852
Value of total assets at beginning of year	2012-06-30	$2,182,015
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$3,796
Total interest from all sources	2012-06-30	$22,939
Total dividends received (eg from common stock, registered investment company shares)	2012-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	No
Was this plan covered by a fidelity bond	2012-06-30	Yes
Value of fidelity bond cover	2012-06-30	$200,000
If this is an individual account plan, was there a blackout period	2012-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Contributions received from participants	2012-06-30	$149,059
Participant contributions at end of year	2012-06-30	$5,669
Participant contributions at beginning of year	2012-06-30	$11,147
Income. Received or receivable in cash from other sources (including rollovers)	2012-06-30	$24,486
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-06-30	No
Value of net income/loss	2012-06-30	$226,837
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$2,408,852
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$2,182,015
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-06-30	No
Were any leases to which the plan was party in default or uncollectible	2012-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-06-30	$1,626,299
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-06-30	$1,448,573
Interest earned on other investments	2012-06-30	$22,939
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-06-30	$772,262
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-06-30	$713,635
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-06-30	$-18,772
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-06-30	No
Was there a failure to transmit to the plan any participant contributions	2012-06-30	No
Has the plan failed to provide any benefit when due under the plan	2012-06-30	No
Contributions received in cash from employer	2012-06-30	$116,917
Employer contributions (assets) at end of year	2012-06-30	$4,622
Employer contributions (assets) at beginning of year	2012-06-30	$8,660
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-06-30	$63,996
Contract administrator fees	2012-06-30	$3,796
Did the plan have assets held for investment	2012-06-30	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	2012-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2012-06-30	Disclaimer
Accountancy firm name	2012-06-30	WIPFLI, LLP
Accountancy firm EIN	2012-06-30	390758449
2011 : WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$0
Total income from all sources (including contributions)	2011-06-30	$590,235
Total loss/gain on sale of assets	2011-06-30	$0
Total of all expenses incurred	2011-06-30	$71,192
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-06-30	$67,914
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-06-30	$276,287
Value of total assets at end of year	2011-06-30	$2,182,015
Value of total assets at beginning of year	2011-06-30	$1,662,972
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-06-30	$3,278
Total interest from all sources	2011-06-30	$21,350
Total dividends received (eg from common stock, registered investment company shares)	2011-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-06-30	No
Was this plan covered by a fidelity bond	2011-06-30	Yes
Value of fidelity bond cover	2011-06-30	$200,000
If this is an individual account plan, was there a blackout period	2011-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2011-06-30	No
Contributions received from participants	2011-06-30	$156,739
Participant contributions at end of year	2011-06-30	$11,147
Participant contributions at beginning of year	2011-06-30	$12,013
Income. Received or receivable in cash from other sources (including rollovers)	2011-06-30	$7,798
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Value of net income/loss	2011-06-30	$519,043
Value of net assets at end of year (total assets less liabilities)	2011-06-30	$2,182,015
Value of net assets at beginning of year (total assets less liabilities)	2011-06-30	$1,662,972
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-06-30	No
Were any leases to which the plan was party in default or uncollectible	2011-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-06-30	$1,448,573
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-06-30	$1,642,970
Interest earned on other investments	2011-06-30	$21,350
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-06-30	$713,635
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-06-30	$292,598
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-06-30	No
Was there a failure to transmit to the plan any participant contributions	2011-06-30	Yes
Has the plan failed to provide any benefit when due under the plan	2011-06-30	No
Contributions received in cash from employer	2011-06-30	$111,750
Employer contributions (assets) at end of year	2011-06-30	$8,660
Employer contributions (assets) at beginning of year	2011-06-30	$7,989
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-06-30	$67,914
Contract administrator fees	2011-06-30	$3,278
Did the plan have assets held for investment	2011-06-30	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	2011-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2011-06-30	Disclaimer
Accountancy firm name	2011-06-30	WIPFLI, LLP
Accountancy firm EIN	2011-06-30	390758449
2010 : WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-06-30	$0

Form 5500 Responses for WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN

2013: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan funding arrangement – Trust	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement - Trust	Yes
2012: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement - Trust	Yes
2011: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes
2010: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Submission has been amended	No
2010-07-01	This submission is the final filing	No
2010-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-07-01	Plan is a collectively bargained plan	No
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan funding arrangement – Trust	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement - Trust	Yes
2009: WILD ROSE COMMUNITY MEMORIAL HOSPITAL, INC. 403 (B) TDA PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	Yes
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	WILD ROSE COMMUNITY MEMORIAL HOSPITAL INC.
Employer identification number (EIN):	396089134
NAIC Classification:	622000
NAIC Description:	Hospitals