401k Plan data: 403B PLAN FOR SIOUXLAND BLOOD BANK plan

403B PLAN FOR SIOUXLAND BLOOD BANK 401k Plan overview

Plan Name	403B PLAN FOR SIOUXLAND BLOOD BANK
Plan identification number	002

403B PLAN FOR SIOUXLAND BLOOD BANK Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

SIOUXLAND COMMUNITY BLOOD BANK has sponsored the creation of one or more 401k plans.

Company Name: SIOUXLAND COMMUNITY BLOOD BANK

Employer identification number (EIN): 420929863

NAIC Classification: 621900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 403B PLAN FOR SIOUXLAND BLOOD BANK

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2011-01-01 CHERYL RITTER
002 2009-01-01 JANETTE TWAIT JANETTE TWAIT 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2011-01-01	CHERYL RITTER
002	2009-01-01	JANETTE TWAIT		JANETTE TWAIT	2010-10-14

Plan Statistics for 403B PLAN FOR SIOUXLAND BLOOD BANK

401k plan membership statisitcs for 403B PLAN FOR SIOUXLAND BLOOD BANK

Measure Date Value
2011: 403B PLAN FOR SIOUXLAND BLOOD BANK 2011 401k membership
Total participants, beginning-of-year 2011-01-01 61
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 0
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 0
Number of participants with account balances 2011-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: 403B PLAN FOR SIOUXLAND BLOOD BANK 2009 401k membership
Total participants, beginning-of-year 2009-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 104
Number of other retired or separated participants entitled to future benefits 2009-01-01 16
Total of all active and inactive participants 2009-01-01 120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 121
Number of participants with account balances 2009-01-01 62

Measure	Date	Value
2011: 403B PLAN FOR SIOUXLAND BLOOD BANK 2011 401k membership
Total participants, beginning-of-year	2011-01-01	61
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	0
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	0
Number of participants with account balances	2011-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: 403B PLAN FOR SIOUXLAND BLOOD BANK 2009 401k membership
Total participants, beginning-of-year	2009-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	104
Number of other retired or separated participants entitled to future benefits	2009-01-01	16
Total of all active and inactive participants	2009-01-01	120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	121
Number of participants with account balances	2009-01-01	62

Financial Data on 403B PLAN FOR SIOUXLAND BLOOD BANK

Measure	Date	Value
2011 : 403B PLAN FOR SIOUXLAND BLOOD BANK 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets from this plan	2011-12-31	$1,866,385
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	$137,236
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$422,987
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$422,060
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$145,067
Value of total assets at end of year	2011-12-31	$0
Value of total assets at beginning of year	2011-12-31	$2,152,136
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$927
Total interest from all sources	2011-12-31	$10,009
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2011-12-31	$0
Was this plan covered by a fidelity bond	2011-12-31	No
If this is an individual account plan, was there a blackout period	2011-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$91,518
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	$-285,751
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$2,152,136
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 pooled separate accounts at beginning of year	2011-12-31	$1,573,166
Interest earned on other investments	2011-12-31	$10,009
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$578,970
Net investment gain/loss from pooled separate accounts	2011-12-31	$-17,840
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	$53,549
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$422,060
Contract administrator fees	2011-12-31	$927
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	Yes
Did the plan have assets held for investment	2011-12-31	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	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	Yes
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	MCGOWEN, HURST, CLARK & SMITH PC
Accountancy firm EIN	2011-12-31	421104473
2010 : 403B PLAN FOR SIOUXLAND BLOOD BANK 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$450,902
Total of all expenses incurred	2010-12-31	$318,473
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$317,292
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$233,679
Value of total assets at end of year	2010-12-31	$2,152,136
Value of total assets at beginning of year	2010-12-31	$2,019,707
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,181
Total interest from all sources	2010-12-31	$17,795
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	No
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	$126,433
Administrative expenses (other) incurred	2010-12-31	$1,181
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	$132,429
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$2,152,136
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,019,707
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 pooled separate accounts at end of year	2010-12-31	$1,573,166
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$1,373,091
Interest earned on other investments	2010-12-31	$17,795
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$578,970
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$646,616
Net investment gain/loss from pooled separate accounts	2010-12-31	$199,428
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	$107,246
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$317,292
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	MCGOWEN, HURST, CLARK & SMITH P.C.
Accountancy firm EIN	2010-12-31	421104473

Form 5500 Responses for 403B PLAN FOR SIOUXLAND BLOOD BANK

2011: 403B PLAN FOR SIOUXLAND BLOOD BANK 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	Yes
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
2009: 403B PLAN FOR SIOUXLAND BLOOD BANK 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	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:	SIOUXLAND COMMUNITY BLOOD BANK
Employer identification number (EIN):	420929863
NAIC Classification:	621900