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MENDOTA COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 401k Plan overview

Plan NameMENDOTA COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN
Plan identification number 003

MENDOTA COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Money purchase (other than target benefit)
  • 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.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

MENDOTA COMMUNITY HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:MENDOTA COMMUNITY HOSPITAL
Employer identification number (EIN):362167785
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MENDOTA COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032012-01-01KIM KENNEDY2013-04-12 KIM KENNEDY2013-04-12
0032011-01-01KIM KENNEDY2012-07-19 KIM KENNEDY2012-07-19
0032009-01-01KIM KENNEDY KIM KENNEDY2010-07-26

Plan Statistics for MENDOTA COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN

401k plan membership statisitcs for MENDOTA COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN

Measure Date Value
2009: MENDOTA COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01268
Total number of active participants reported on line 7a of the Form 55002009-01-01248
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0120
Total of all active and inactive participants2009-01-01268
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01268
Number of participants with account balances2009-01-01224
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-013

Financial Data on MENDOTA COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN

Measure Date Value
2010 : MENDOTA COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2010 401k financial data
Unrealized appreciation/depreciation of real estate assets2010-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2010-12-31$0
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total transfer of assets to this plan2010-12-31$0
Total transfer of assets from this plan2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
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$314,545
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$2,969,179
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$2,969,179
Value of total corrective distributions2010-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$189,669
Value of total assets at end of year2010-12-31$6,486
Value of total assets at beginning of year2010-12-31$2,661,120
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$0
Total income from rents2010-12-31$0
Total interest from all sources2010-12-31$10,606
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$2,922
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$2,922
Administrative expenses professional fees incurred2010-12-31$0
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$1,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Funding deficiency by the employer to the plan for this plan year2010-12-31$0
Minimum employer required contribution for this plan year2010-12-31$189,669
Amount contributed by the employer to the plan for this plan year2010-12-31$189,669
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Amount of non-exempt transactions with any party-in-interest2010-12-31$0
Contributions received from participants2010-12-31$0
Participant contributions at end of year2010-12-31$0
Participant contributions at beginning of year2010-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2010-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$0
Other income not declared elsewhere2010-12-31$0
Administrative expenses (other) incurred2010-12-31$0
Liabilities. Value of operating payables at beginning of year2010-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-2,654,634
Value of net assets at end of year (total assets less liabilities)2010-12-31$6,486
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$2,661,120
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year2010-12-31$0
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2010-12-31$0
Investment advisory and management fees2010-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$6,486
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$2,188,507
Income. Interest from loans (other than to participants)2010-12-31$0
Interest earned on other investments2010-12-31$10,606
Income. Interest from US Government securities2010-12-31$0
Income. Interest from corporate debt instruments2010-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$472,613
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$111,348
Net investment gain/loss from pooled separate accounts2010-12-31$0
Net investment gain or loss from common/collective trusts2010-12-31$0
Net gain/loss from 103.12 investment entities2010-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$189,669
Employer contributions (assets) at end of year2010-12-31$0
Employer contributions (assets) at beginning of year2010-12-31$0
Income. Dividends from preferred stock2010-12-31$0
Income. Dividends from common stock2010-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$2,969,179
Contract administrator fees2010-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$0
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Aggregate proceeds on sale of assets2010-12-31$0
Aggregate carrying amount (costs) on sale of assets2010-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2010-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31BKD, LLP
Accountancy firm EIN2010-12-31440160260
2009 : MENDOTA COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0
Funding deficiency by the employer to the plan for this plan year2009-12-31$0
Minimum employer required contribution for this plan year2009-12-31$255,736
Amount contributed by the employer to the plan for this plan year2009-12-31$255,736

Form 5500 Responses for MENDOTA COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN

2009: MENDOTA COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number441462
Policy instance 1
Insurance contract or identification number441462
Number of Individuals Covered40
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,663
Total amount of fees paid to insurance companyUSD $241
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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