401k Plan data: MERCY HOSPITAL OF DEFIANCE 401(K) PLAN plan

MERCY HOSPITAL OF DEFIANCE 401(K) PLAN 401k Plan overview

Plan Name	MERCY HOSPITAL OF DEFIANCE 401(K) PLAN
Plan identification number	001

MERCY HOSPITAL OF DEFIANCE 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

MERCY HOSPITAL OF DEFIANCE LLC has sponsored the creation of one or more 401k plans.

Company Name: MERCY HOSPITAL OF DEFIANCE LLC

Employer identification number (EIN): 020701635

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MERCY HOSPITAL OF DEFIANCE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-08-01 CATHY KELLER CATHY KELLER 2013-05-28
001 2011-08-01 SONYA SELHORST SONYA SELHORST 2013-01-25
001 2009-08-01 WILLIAM A. SUTTON WILLIAM A. SUTTON 2011-05-13

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2012-08-01	CATHY KELLER	CATHY KELLER	2013-05-28
001	2011-08-01	SONYA SELHORST	SONYA SELHORST	2013-01-25
001	2009-08-01	WILLIAM A. SUTTON	WILLIAM A. SUTTON	2011-05-13

Plan Statistics for MERCY HOSPITAL OF DEFIANCE 401(K) PLAN

401k plan membership statisitcs for MERCY HOSPITAL OF DEFIANCE 401(K) PLAN

Measure Date Value
2012: MERCY HOSPITAL OF DEFIANCE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-08-01 150
Total number of active participants reported on line 7a of the Form 5500 2012-08-01 0
Number of retired or separated participants receiving benefits 2012-08-01 0
Total of all active and inactive participants 2012-08-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-08-01 0
Total participants 2012-08-01 0
Number of participants with account balances 2012-08-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-08-01 0
2011: MERCY HOSPITAL OF DEFIANCE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-08-01 150
Total number of active participants reported on line 7a of the Form 5500 2011-08-01 149
Number of retired or separated participants receiving benefits 2011-08-01 0
Total of all active and inactive participants 2011-08-01 149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-08-01 1
Total participants 2011-08-01 150
Number of participants with account balances 2011-08-01 150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-08-01 12
2009: MERCY HOSPITAL OF DEFIANCE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-08-01 135
Total number of active participants reported on line 7a of the Form 5500 2009-08-01 116
Number of other retired or separated participants entitled to future benefits 2009-08-01 13
Total of all active and inactive participants 2009-08-01 129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-08-01 1
Total participants 2009-08-01 130
Number of participants with account balances 2009-08-01 130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-08-01 6

Measure	Date	Value
2012: MERCY HOSPITAL OF DEFIANCE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-08-01	150
Total number of active participants reported on line 7a of the Form 5500	2012-08-01	0
Number of retired or separated participants receiving benefits	2012-08-01	0
Total of all active and inactive participants	2012-08-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-08-01	0
Total participants	2012-08-01	0
Number of participants with account balances	2012-08-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-08-01	0
2011: MERCY HOSPITAL OF DEFIANCE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-08-01	150
Total number of active participants reported on line 7a of the Form 5500	2011-08-01	149
Number of retired or separated participants receiving benefits	2011-08-01	0
Total of all active and inactive participants	2011-08-01	149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-08-01	1
Total participants	2011-08-01	150
Number of participants with account balances	2011-08-01	150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-08-01	12
2009: MERCY HOSPITAL OF DEFIANCE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-08-01	135
Total number of active participants reported on line 7a of the Form 5500	2009-08-01	116
Number of other retired or separated participants entitled to future benefits	2009-08-01	13
Total of all active and inactive participants	2009-08-01	129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-08-01	1
Total participants	2009-08-01	130
Number of participants with account balances	2009-08-01	130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-08-01	6

Financial Data on MERCY HOSPITAL OF DEFIANCE 401(K) PLAN

Measure	Date	Value
2012 : MERCY HOSPITAL OF DEFIANCE 401(K) PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$89,630
Total unrealized appreciation/depreciation of assets	2012-12-31	$89,630
Total income from all sources (including contributions)	2012-12-31	$95,600
Total of all expenses incurred	2012-12-31	$2,670,517
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$2,659,221
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$5,137
Value of total assets at end of year	2012-12-31	$0
Value of total assets at beginning of year	2012-12-31	$2,574,917
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$11,296
Total interest from all sources	2012-12-31	$833
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	Yes
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$250,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Participant contributions at beginning of year	2012-12-31	$60,999
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$5,137
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-12-31	$2,659,221
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	$-2,574,917
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$2,574,917
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 registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$2,367,935
Interest on participant loans	2012-12-31	$833
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$99,067
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
Employer contributions (assets) at beginning of year	2012-12-31	$46,916
Contract administrator fees	2012-12-31	$11,296
Did the plan have assets held for investment	2012-12-31	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	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	Yes
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	SHULTZ, HUBER & ASSOCIATES, INC.
Accountancy firm EIN	2012-12-31	341769212
Unrealized appreciation/depreciation of other (non real estate) assets	2012-07-31	$42,874
Total unrealized appreciation/depreciation of assets	2012-07-31	$42,874
Total income from all sources (including contributions)	2012-07-31	$197,200
Total of all expenses incurred	2012-07-31	$128,503
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-07-31	$126,778
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-07-31	$150,917
Value of total assets at end of year	2012-07-31	$2,574,917
Value of total assets at beginning of year	2012-07-31	$2,506,220
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-07-31	$1,725
Total interest from all sources	2012-07-31	$3,409
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-07-31	Yes
Was this plan covered by a fidelity bond	2012-07-31	Yes
Value of fidelity bond cover	2012-07-31	$250,000
If this is an individual account plan, was there a blackout period	2012-07-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-07-31	No
Contributions received from participants	2012-07-31	$95,757
Participant contributions at end of year	2012-07-31	$60,999
Participant contributions at beginning of year	2012-07-31	$64,739
Income. Received or receivable in cash from other sources (including rollovers)	2012-07-31	$8,244
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-07-31	No
Value of net income/loss	2012-07-31	$68,697
Value of net assets at end of year (total assets less liabilities)	2012-07-31	$2,574,917
Value of net assets at beginning of year (total assets less liabilities)	2012-07-31	$2,506,220
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-07-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-07-31	No
Were any leases to which the plan was party in default or uncollectible	2012-07-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-07-31	$2,367,935
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-07-31	$2,196,032
Interest on participant loans	2012-07-31	$3,409
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-07-31	$99,067
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-07-31	$117,056
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-07-31	No
Was there a failure to transmit to the plan any participant contributions	2012-07-31	No
Has the plan failed to provide any benefit when due under the plan	2012-07-31	No
Contributions received in cash from employer	2012-07-31	$46,916
Employer contributions (assets) at end of year	2012-07-31	$46,916
Employer contributions (assets) at beginning of year	2012-07-31	$128,393
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-07-31	$126,778
Contract administrator fees	2012-07-31	$1,725
Did the plan have assets held for investment	2012-07-31	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	2012-07-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-07-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-07-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-07-31	Disclaimer
Accountancy firm name	2012-07-31	SHULTZ, HUBER & ASSOCIATES, INC.
Accountancy firm EIN	2012-07-31	341769212
2011 : MERCY HOSPITAL OF DEFIANCE 401(K) PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-07-31	$277,216
Total unrealized appreciation/depreciation of assets	2011-07-31	$277,216
Total income from all sources (including contributions)	2011-07-31	$742,286
Total of all expenses incurred	2011-07-31	$174,953
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-07-31	$173,003
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-07-31	$462,561
Value of total assets at end of year	2011-07-31	$2,506,220
Value of total assets at beginning of year	2011-07-31	$1,938,887
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-07-31	$1,950
Total interest from all sources	2011-07-31	$2,509
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-07-31	No
Was this plan covered by a fidelity bond	2011-07-31	Yes
Value of fidelity bond cover	2011-07-31	$232,000
If this is an individual account plan, was there a blackout period	2011-07-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-07-31	No
Contributions received from participants	2011-07-31	$235,032
Participant contributions at end of year	2011-07-31	$64,739
Participant contributions at beginning of year	2011-07-31	$51,692
Income. Received or receivable in cash from other sources (including rollovers)	2011-07-31	$87,737
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-07-31	No
Value of net income/loss	2011-07-31	$567,333
Value of net assets at end of year (total assets less liabilities)	2011-07-31	$2,506,220
Value of net assets at beginning of year (total assets less liabilities)	2011-07-31	$1,938,887
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-07-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-07-31	No
Were any leases to which the plan was party in default or uncollectible	2011-07-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-07-31	$2,196,032
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-07-31	$1,661,227
Interest on participant loans	2011-07-31	$2,509
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-07-31	$117,056
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-07-31	$101,617
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-07-31	No
Was there a failure to transmit to the plan any participant contributions	2011-07-31	No
Has the plan failed to provide any benefit when due under the plan	2011-07-31	No
Contributions received in cash from employer	2011-07-31	$139,792
Employer contributions (assets) at end of year	2011-07-31	$128,393
Employer contributions (assets) at beginning of year	2011-07-31	$124,351
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-07-31	$173,003
Contract administrator fees	2011-07-31	$1,950
Did the plan have assets held for investment	2011-07-31	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	2011-07-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-07-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-07-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-07-31	Disclaimer
Accountancy firm name	2011-07-31	SHULTZ, HUBER & ASSOCIATES, INC.
Accountancy firm EIN	2011-07-31	341769212

Form 5500 Responses for MERCY HOSPITAL OF DEFIANCE 401(K) PLAN

2012: MERCY HOSPITAL OF DEFIANCE 401(K) PLAN 2012 form 5500 responses
2012-08-01	Type of plan entity	Single employer plan
2012-08-01	This submission is the final filing	Yes
2012-08-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-08-01	Plan funding arrangement – Insurance	Yes
2012-08-01	Plan funding arrangement – Trust	Yes
2012-08-01	Plan benefit arrangement – Insurance	Yes
2012-08-01	Plan benefit arrangement - Trust	Yes
2011: MERCY HOSPITAL OF DEFIANCE 401(K) PLAN 2011 form 5500 responses
2011-08-01	Type of plan entity	Single employer plan
2011-08-01	Plan funding arrangement – Insurance	Yes
2011-08-01	Plan funding arrangement – Trust	Yes
2011-08-01	Plan benefit arrangement – Insurance	Yes
2011-08-01	Plan benefit arrangement - Trust	Yes
2009: MERCY HOSPITAL OF DEFIANCE 401(K) PLAN 2009 form 5500 responses
2009-08-01	Type of plan entity	Single employer plan
2009-08-01	Plan funding arrangement – Insurance	Yes
2009-08-01	Plan funding arrangement – Trust	Yes
2009-08-01	Plan benefit arrangement – Insurance	Yes
2009-08-01	Plan benefit arrangement - Trust	Yes

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Company Name:	MERCY HOSPITAL OF DEFIANCE LLC
Employer identification number (EIN):	020701635
NAIC Classification:	622000
NAIC Description:	Hospitals