401k Plan data: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN plan

SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN
Plan identification number	002

SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
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 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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

SCOTT COUNTY HOSPITAL, INC. has sponsored the creation of one or more 401k plans.

Company Name: SCOTT COUNTY HOSPITAL, INC.

Employer identification number (EIN): 481185204

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01
002 2016-01-01 JOE S. MEYER 2018-09-20
002 2016-01-01 JOE S. MEYER 2018-09-28
002 2015-01-01
002 2014-01-01 PAMELA R. WHEELER
002 2013-01-01 PAM WHEELER
002 2012-01-01 JOE S MEYER
002 2011-01-01 JOE S MEYER
002 2009-01-01 BETH SAVAGE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2016-01-01
002	2016-01-01	JOE S. MEYER	2018-09-20
002	2016-01-01	JOE S. MEYER	2018-09-28
002	2015-01-01
002	2014-01-01	PAMELA R. WHEELER
002	2013-01-01	PAM WHEELER
002	2012-01-01	JOE S MEYER
002	2011-01-01	JOE S MEYER
002	2009-01-01	BETH SAVAGE

Plan Statistics for SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2016: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 185
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 151
Number of retired or separated participants receiving benefits 2016-01-01 3
Number of other retired or separated participants entitled to future benefits 2016-01-01 33
Total of all active and inactive participants 2016-01-01 187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 187
Number of participants with account balances 2016-01-01 185
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 15
2015: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 191
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 148
Number of retired or separated participants receiving benefits 2015-01-01 8
Number of other retired or separated participants entitled to future benefits 2015-01-01 34
Total of all active and inactive participants 2015-01-01 190
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 190
Number of participants with account balances 2015-01-01 185
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 14
2014: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 171
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 151
Number of retired or separated participants receiving benefits 2014-01-01 9
Number of other retired or separated participants entitled to future benefits 2014-01-01 26
Total of all active and inactive participants 2014-01-01 186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 186
Number of participants with account balances 2014-01-01 181
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 16
2013: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 143
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 137
Number of retired or separated participants receiving benefits 2013-01-01 1
Number of other retired or separated participants entitled to future benefits 2013-01-01 20
Total of all active and inactive participants 2013-01-01 158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 158
Number of participants with account balances 2013-01-01 153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 6
2012: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 146
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 137
Number of retired or separated participants receiving benefits 2012-01-01 2
Number of other retired or separated participants entitled to future benefits 2012-01-01 3
Total of all active and inactive participants 2012-01-01 142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 142
Number of participants with account balances 2012-01-01 141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 10
2011: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 135
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 9
Total of all active and inactive participants 2011-01-01 146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 146
Number of participants with account balances 2011-01-01 142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 8
2009: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 119
Number of retired or separated participants receiving benefits 2009-01-01 3
Number of other retired or separated participants entitled to future benefits 2009-01-01 14
Total of all active and inactive participants 2009-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 136
Number of participants with account balances 2009-01-01 127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 3

Measure	Date	Value
2016: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	185
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	151
Number of retired or separated participants receiving benefits	2016-01-01	3
Number of other retired or separated participants entitled to future benefits	2016-01-01	33
Total of all active and inactive participants	2016-01-01	187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	187
Number of participants with account balances	2016-01-01	185
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	15
2015: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	191
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	148
Number of retired or separated participants receiving benefits	2015-01-01	8
Number of other retired or separated participants entitled to future benefits	2015-01-01	34
Total of all active and inactive participants	2015-01-01	190
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	190
Number of participants with account balances	2015-01-01	185
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	14
2014: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	171
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	151
Number of retired or separated participants receiving benefits	2014-01-01	9
Number of other retired or separated participants entitled to future benefits	2014-01-01	26
Total of all active and inactive participants	2014-01-01	186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	186
Number of participants with account balances	2014-01-01	181
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	16
2013: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	143
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	137
Number of retired or separated participants receiving benefits	2013-01-01	1
Number of other retired or separated participants entitled to future benefits	2013-01-01	20
Total of all active and inactive participants	2013-01-01	158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	158
Number of participants with account balances	2013-01-01	153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	6
2012: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	146
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	137
Number of retired or separated participants receiving benefits	2012-01-01	2
Number of other retired or separated participants entitled to future benefits	2012-01-01	3
Total of all active and inactive participants	2012-01-01	142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	142
Number of participants with account balances	2012-01-01	141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	10
2011: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	135
Number of retired or separated participants receiving benefits	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	9
Total of all active and inactive participants	2011-01-01	146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	146
Number of participants with account balances	2011-01-01	142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	8
2009: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	119
Number of retired or separated participants receiving benefits	2009-01-01	3
Number of other retired or separated participants entitled to future benefits	2009-01-01	14
Total of all active and inactive participants	2009-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	136
Number of participants with account balances	2009-01-01	127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	3

Financial Data on SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2016 : SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$1,271,832
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$719,142
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$719,142
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$951,032
Value of total assets at end of year	2016-12-31	$8,141,888
Value of total assets at beginning of year	2016-12-31	$7,589,198
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$0
Total interest from all sources	2016-12-31	$1,087
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$396,581
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$21,013
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$298
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$298
Total non interest bearing cash at end of year	2016-12-31	$1,365
Total non interest bearing cash at beginning of year	2016-12-31	$5,032
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$552,690
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$8,141,888
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$7,589,198
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in pooled separate accounts at end of year	2016-12-31	$7,694,777
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$7,153,382
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$1,087
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$155,329
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$154,242
Net investment gain/loss from pooled separate accounts	2016-12-31	$319,713
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$533,438
Employer contributions (assets) at end of year	2016-12-31	$290,119
Employer contributions (assets) at beginning of year	2016-12-31	$276,244
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$719,142
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	GEORGE, BOWERMAN, NOEL, P.A.
Accountancy firm EIN	2016-12-31	481064153
2015 : SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$824,396
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$925,489
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$925,339
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$928,213
Value of total assets at end of year	2015-12-31	$7,589,198
Value of total assets at beginning of year	2015-12-31	$7,690,291
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$150
Total interest from all sources	2015-12-31	$90
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$150
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$357,793
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$71,235
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$298
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$267
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Total non interest bearing cash at end of year	2015-12-31	$5,032
Total non interest bearing cash at beginning of year	2015-12-31	$9,953
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-101,093
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$7,589,198
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$7,690,291
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in pooled separate accounts at end of year	2015-12-31	$7,153,382
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$7,284,738
Interest earned on other investments	2015-12-31	$13
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$77
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$154,242
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$154,164
Net investment gain/loss from pooled separate accounts	2015-12-31	$-103,907
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$499,185
Employer contributions (assets) at end of year	2015-12-31	$276,244
Employer contributions (assets) at beginning of year	2015-12-31	$241,169
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$925,339
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	GEORGE, BOWERMAN, NOEL, P.A.
Accountancy firm EIN	2015-12-31	481064153
2014 : SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$1,158,404
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$1,586,511
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$1,586,511
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$831,858
Value of total assets at end of year	2014-12-31	$7,690,291
Value of total assets at beginning of year	2014-12-31	$8,118,398
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total interest from all sources	2014-12-31	$151
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
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	$346,808
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$53
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$39,778
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$267
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$0
Total non interest bearing cash at end of year	2014-12-31	$9,953
Total non interest bearing cash at beginning of year	2014-12-31	$3,330
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	$-428,107
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$7,690,291
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$8,118,398
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
Value of interest in pooled separate accounts at end of year	2014-12-31	$7,284,738
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$7,059,868
Interest earned on other investments	2014-12-31	$8
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$83,589
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$83,589
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$143
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$154,164
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$744,936
Net investment gain/loss from pooled separate accounts	2014-12-31	$326,395
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	$445,272
Employer contributions (assets) at end of year	2014-12-31	$241,169
Employer contributions (assets) at beginning of year	2014-12-31	$226,622
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$1,586,511
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	GEORGE, BOWERMAN, NOEL, P.A.
Accountancy firm EIN	2014-12-31	481064153
2013 : SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$1,845,227
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$338,436
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$338,436
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$905,891
Value of total assets at end of year	2013-12-31	$8,118,398
Value of total assets at beginning of year	2013-12-31	$6,611,607
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$0
Total interest from all sources	2013-12-31	$200
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$939,136
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	$939,136
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	$358,611
Participant contributions at end of year	2013-12-31	$53
Participant contributions at beginning of year	2013-12-31	$3
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$131,206
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$-38
Total non interest bearing cash at end of year	2013-12-31	$3,330
Total non interest bearing cash at beginning of year	2013-12-31	$7,935
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	$1,506,791
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$8,118,398
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$6,611,607
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
Value of interest in pooled separate accounts at end of year	2013-12-31	$7,059,868
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$6,382,318
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$83,589
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$200
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$744,936
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$16,353
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	$416,074
Employer contributions (assets) at end of year	2013-12-31	$226,622
Employer contributions (assets) at beginning of year	2013-12-31	$205,036
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$338,436
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	GEORGE, BOWERMAN, NOEL, P.A.
Accountancy firm EIN	2013-12-31	481064153
2012 : SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$1,484,297
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$705,745
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$705,745
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$723,773
Value of total assets at end of year	2012-12-31	$6,611,607
Value of total assets at beginning of year	2012-12-31	$5,833,055
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$0
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
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	$308,823
Participant contributions at end of year	2012-12-31	$3
Participant contributions at beginning of year	2012-12-31	$-220
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$35,630
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$-38
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$0
Total non interest bearing cash at end of year	2012-12-31	$7,935
Total non interest bearing cash at beginning of year	2012-12-31	$2,499
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	$778,552
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$6,611,607
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$5,833,055
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
Value of interest in pooled separate accounts at end of year	2012-12-31	$6,382,318
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$5,625,084
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$16,353
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$12,697
Net investment gain/loss from pooled separate accounts	2012-12-31	$760,524
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	$379,320
Employer contributions (assets) at end of year	2012-12-31	$205,036
Employer contributions (assets) at beginning of year	2012-12-31	$192,995
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$705,745
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	GEORGE, BOWERMAN, NOEL, P.A.
Accountancy firm EIN	2012-12-31	481064153
2011 : SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$517
Total income from all sources (including contributions)	2011-12-31	$469,477
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$400,509
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$400,445
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$666,137
Value of total assets at end of year	2011-12-31	$5,833,055
Value of total assets at beginning of year	2011-12-31	$5,764,604
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$64
Total interest from all sources	2011-12-31	$0
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	No
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	$275,680
Participant contributions at end of year	2011-12-31	$-220
Participant contributions at beginning of year	2011-12-31	$1,838
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$33,517
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$517
Administrative expenses (other) incurred	2011-12-31	$64
Total non interest bearing cash at end of year	2011-12-31	$2,499
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	$68,968
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$5,833,055
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$5,764,087
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 end of year	2011-12-31	$5,625,084
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$5,564,614
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$12,697
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$10,367
Net investment gain/loss from pooled separate accounts	2011-12-31	$-196,628
Net investment gain or loss from common/collective trusts	2011-12-31	$-32
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
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	$356,940
Employer contributions (assets) at end of year	2011-12-31	$192,995
Employer contributions (assets) at beginning of year	2011-12-31	$187,785
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$400,445
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	GEORGE, BOWERMAN, NOEL, P.A.
Accountancy firm EIN	2011-12-31	481064153
2010 : SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING 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	$517
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$1,416,432
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$232,307
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$232,307
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$742,476
Value of total assets at end of year	2010-12-31	$5,764,604
Value of total assets at beginning of year	2010-12-31	$4,579,962
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
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	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	$264,669
Participant contributions at end of year	2010-12-31	$1,838
Participant contributions at beginning of year	2010-12-31	$1,838
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$137,226
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$517
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	$1,184,125
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$5,764,087
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$4,579,962
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	$5,564,614
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$4,406,439
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$10,367
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$673,956
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	$340,581
Employer contributions (assets) at end of year	2010-12-31	$187,785
Employer contributions (assets) at beginning of year	2010-12-31	$171,685
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$232,307
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	GEORGE, BOWERMAN, NOEL, P.A.
Accountancy firm EIN	2010-12-31	481064153

Form 5500 Responses for SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN

2016: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING 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	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING 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 – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING 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 – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: SCOTT COUNTY HOSPITAL, INC. 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

82895

Policy instance

Insurance contract or identification number	82895
Number of Individuals Covered	178
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $19,314
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,164
Insurance broker organization code?	3
Insurance broker name	HEARTLAND CONSULTING GROUP, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

82895

Policy instance

Insurance contract or identification number	82895
Number of Individuals Covered	177
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $19,371
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,371
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE INVESTMENT RESEARCH INC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

82895

Policy instance

Insurance contract or identification number	82895
Number of Individuals Covered	159
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $17,995
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,995
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE INVESTMENT RESEARCH INC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

Policy instance

Number of Individuals Covered	142
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $15,295
Total amount of fees paid to insurance company	USD $14
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,295
Insurance broker organization code?	3
Amount paid for insurance broker fees	14
Additional information about fees paid to insurance broker	REDEMPTION FEE
Insurance broker name	FIDELITY MANAGEMENT & RESEARCH COMP

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

Policy instance

Number of Individuals Covered	139
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $14,726
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

Policy instance

Number of Individuals Covered	138
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $12,133
Total amount of fees paid to insurance company	USD $25
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,751
Insurance broker organization code?	3
Amount paid for insurance broker fees	25
Additional information about fees paid to insurance broker	IRA R/O PAYMENT
Insurance broker name	CITIZENS BANK AND TRUST

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Company Name:	SCOTT COUNTY HOSPITAL, INC.
Employer identification number (EIN):	481185204
NAIC Classification:	622000
NAIC Description:	Hospitals