401k Plan data: CORRY MEMORIAL HOSPITAL BENEFIT PLAN plan

CORRY MEMORIAL HOSPITAL BENEFIT PLAN 401k Plan overview

Plan Name	CORRY MEMORIAL HOSPITAL BENEFIT PLAN
Plan identification number	501

CORRY MEMORIAL HOSPITAL BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

CORRY MEMORIAL HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: CORRY MEMORIAL HOSPITAL

Employer identification number (EIN): 250987222

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CORRY MEMORIAL HOSPITAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-02-01 SHARONKIMMY
501 2015-02-01 STEVEN INMAN 2021-04-15
501 2014-02-01 SHARONKIMMY
501 2013-02-01 SHARON KIMMY
501 2012-02-01 GARY WEBB GARY WEBB 2013-11-11
501 2011-02-01 GARY WEBB
501 2009-02-01 GARY WEBB

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2015-02-01	SHARONKIMMY
501	2015-02-01	STEVEN INMAN	2021-04-15
501	2014-02-01	SHARONKIMMY
501	2013-02-01	SHARON KIMMY
501	2012-02-01	GARY WEBB		GARY WEBB	2013-11-11
501	2011-02-01	GARY WEBB
501	2009-02-01	GARY WEBB

Plan Statistics for CORRY MEMORIAL HOSPITAL BENEFIT PLAN

401k plan membership statisitcs for CORRY MEMORIAL HOSPITAL BENEFIT PLAN

Measure Date Value
2015: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-02-01 117
Total number of active participants reported on line 7a of the Form 5500 2015-02-01 116
Total of all active and inactive participants 2015-02-01 116
Number of retired or separated participants receiving benefits 2015-02-01 0
Number of other retired or separated participants entitled to future benefits 2015-02-01 0
2014: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-02-01 126
Total number of active participants reported on line 7a of the Form 5500 2014-02-01 117
Number of retired or separated participants receiving benefits 2014-02-01 0
Number of other retired or separated participants entitled to future benefits 2014-02-01 0
Total of all active and inactive participants 2014-02-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-02-01 0
Total participants 2014-02-01 117
2013: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-02-01 119
Total number of active participants reported on line 7a of the Form 5500 2013-02-01 126
Number of retired or separated participants receiving benefits 2013-02-01 0
Number of other retired or separated participants entitled to future benefits 2013-02-01 0
Total of all active and inactive participants 2013-02-01 126
2012: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-02-01 133
Total number of active participants reported on line 7a of the Form 5500 2012-02-01 119
Number of retired or separated participants receiving benefits 2012-02-01 0
Number of other retired or separated participants entitled to future benefits 2012-02-01 0
Total of all active and inactive participants 2012-02-01 119
2011: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-02-01 129
Total number of active participants reported on line 7a of the Form 5500 2011-02-01 133
Number of retired or separated participants receiving benefits 2011-02-01 0
Number of other retired or separated participants entitled to future benefits 2011-02-01 0
Total of all active and inactive participants 2011-02-01 133
2009: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-02-01 157
Total number of active participants reported on line 7a of the Form 5500 2009-02-01 149
Number of retired or separated participants receiving benefits 2009-02-01 0
Number of other retired or separated participants entitled to future benefits 2009-02-01 0
Total of all active and inactive participants 2009-02-01 149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-02-01 0

Measure	Date	Value
2015: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-02-01	117
Total number of active participants reported on line 7a of the Form 5500	2015-02-01	116
Total of all active and inactive participants	2015-02-01	116
Number of retired or separated participants receiving benefits	2015-02-01	0
Number of other retired or separated participants entitled to future benefits	2015-02-01	0
2014: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-02-01	126
Total number of active participants reported on line 7a of the Form 5500	2014-02-01	117
Number of retired or separated participants receiving benefits	2014-02-01	0
Number of other retired or separated participants entitled to future benefits	2014-02-01	0
Total of all active and inactive participants	2014-02-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-02-01	0
Total participants	2014-02-01	117
2013: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-02-01	119
Total number of active participants reported on line 7a of the Form 5500	2013-02-01	126
Number of retired or separated participants receiving benefits	2013-02-01	0
Number of other retired or separated participants entitled to future benefits	2013-02-01	0
Total of all active and inactive participants	2013-02-01	126
2012: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-02-01	133
Total number of active participants reported on line 7a of the Form 5500	2012-02-01	119
Number of retired or separated participants receiving benefits	2012-02-01	0
Number of other retired or separated participants entitled to future benefits	2012-02-01	0
Total of all active and inactive participants	2012-02-01	119
2011: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-02-01	129
Total number of active participants reported on line 7a of the Form 5500	2011-02-01	133
Number of retired or separated participants receiving benefits	2011-02-01	0
Number of other retired or separated participants entitled to future benefits	2011-02-01	0
Total of all active and inactive participants	2011-02-01	133
2009: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-02-01	157
Total number of active participants reported on line 7a of the Form 5500	2009-02-01	149
Number of retired or separated participants receiving benefits	2009-02-01	0
Number of other retired or separated participants entitled to future benefits	2009-02-01	0
Total of all active and inactive participants	2009-02-01	149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-02-01	0

Form 5500 Responses for CORRY MEMORIAL HOSPITAL BENEFIT PLAN

2015: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2015 form 5500 responses
2015-02-01	Type of plan entity	Single employer plan
2015-02-01	Submission has been amended	No
2015-02-01	This submission is the final filing	No
2015-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-02-01	Plan is a collectively bargained plan	No
2015-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2014 form 5500 responses
2014-02-01	Type of plan entity	Single employer plan
2014-02-01	Submission has been amended	No
2014-02-01	This submission is the final filing	No
2014-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-02-01	Plan is a collectively bargained plan	No
2014-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2013 form 5500 responses
2013-02-01	Type of plan entity	Single employer plan
2013-02-01	Submission has been amended	No
2013-02-01	This submission is the final filing	No
2013-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-02-01	Plan is a collectively bargained plan	No
2013-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2012 form 5500 responses
2012-02-01	Type of plan entity	Single employer plan
2012-02-01	Submission has been amended	No
2012-02-01	This submission is the final filing	No
2012-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-02-01	Plan is a collectively bargained plan	No
2012-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2011 form 5500 responses
2011-02-01	Type of plan entity	Single employer plan
2011-02-01	Submission has been amended	No
2011-02-01	This submission is the final filing	No
2011-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-02-01	Plan is a collectively bargained plan	No
2011-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: CORRY MEMORIAL HOSPITAL BENEFIT PLAN 2009 form 5500 responses
2009-02-01	Type of plan entity	Single employer plan
2009-02-01	Submission has been amended	No
2009-02-01	This submission is the final filing	No
2009-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-02-01	Plan is a collectively bargained plan	No
2009-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-02-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

401324

Policy instance

Insurance contract or identification number	401324
Number of Individuals Covered	0
Insurance policy start date	2015-02-01
Insurance policy end date	2016-01-31
Total amount of commissions paid to insurance broker	USD $21,452
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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?	No
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
Welfare Benefit Premiums Paid to Carrier	USD $214,516
Commission paid to Insurance Broker	USD $21,452
Insurance broker organization code?	3

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Company Name:	CORRY MEMORIAL HOSPITAL
Employer identification number (EIN):	250987222
NAIC Classification:	622000
NAIC Description:	Hospitals