401k Plan data: DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN plan

DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN 401k Plan overview

Plan Name	DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN
Plan identification number	505

DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN Benefits

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

401k Sponsoring company profile

DELNOR COMMUNITY HEALTH SYSTEM has sponsored the creation of one or more 401k plans.

Company Name: DELNOR COMMUNITY HEALTH SYSTEM

Employer identification number (EIN): 363379958

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2011-09-01 SHAWN FITZGERALD
505 2010-09-01 SHAWN FITZGERALD
505 2009-09-01 MICHAEL KITTOE

Plan id#	Filing Submission Date	Name of Administrator
505	2011-09-01	SHAWN FITZGERALD
505	2010-09-01	SHAWN FITZGERALD
505	2009-09-01	MICHAEL KITTOE

Plan Statistics for DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN

401k plan membership statisitcs for DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN

Measure Date Value
2011: DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year 2011-09-01 1,018
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 0
Number of retired or separated participants receiving benefits 2011-09-01 0
Number of other retired or separated participants entitled to future benefits 2011-09-01 0
Total of all active and inactive participants 2011-09-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-09-01 0
Total participants 2011-09-01 0
2010: DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year 2010-09-01 1,089
Total number of active participants reported on line 7a of the Form 5500 2010-09-01 1,018
Number of retired or separated participants receiving benefits 2010-09-01 0
Total of all active and inactive participants 2010-09-01 1,018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-09-01 0
Total participants 2010-09-01 1,018
2009: DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year 2009-09-01 1,147
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 1,089
Total of all active and inactive participants 2009-09-01 1,089
Total participants 2009-09-01 1,089

Measure	Date	Value
2011: DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year	2011-09-01	1,018
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	0
Number of retired or separated participants receiving benefits	2011-09-01	0
Number of other retired or separated participants entitled to future benefits	2011-09-01	0
Total of all active and inactive participants	2011-09-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-09-01	0
Total participants	2011-09-01	0
2010: DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year	2010-09-01	1,089
Total number of active participants reported on line 7a of the Form 5500	2010-09-01	1,018
Number of retired or separated participants receiving benefits	2010-09-01	0
Total of all active and inactive participants	2010-09-01	1,018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-09-01	0
Total participants	2010-09-01	1,018
2009: DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year	2009-09-01	1,147
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	1,089
Total of all active and inactive participants	2009-09-01	1,089
Total participants	2009-09-01	1,089

Form 5500 Responses for DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN

2011: DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Submission has been amended	No
2011-09-01	This submission is the final filing	Yes
2011-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2011-09-01	Plan is a collectively bargained plan	No
2011-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN 2010 form 5500 responses
2010-09-01	Type of plan entity	Single employer plan
2010-09-01	Submission has been amended	No
2010-09-01	This submission is the final filing	No
2010-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-09-01	Plan is a collectively bargained plan	No
2010-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-09-01	Plan benefit arrangement – Insurance	Yes
2010-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: DELNOR COMMUNITY HEALTH SYSTEM EMPLOYEE BENEFIT HEALTH PLAN 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	Submission has been amended	No
2009-09-01	This submission is the final filing	No
2009-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-09-01	Plan is a collectively bargained plan	No
2009-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes
2009-09-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	DELNOR COMMUNITY HEALTH SYSTEM
Employer identification number (EIN):	363379958
NAIC Classification:	622000
NAIC Description:	Hospitals