401k Plan data: FAUQUIER HEALTH RETIREMENT SAVINGS PLAN plan

FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	FAUQUIER HEALTH RETIREMENT SAVINGS PLAN
Plan identification number	001

FAUQUIER HEALTH RETIREMENT SAVINGS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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(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

FAUQUIER HEALTH SYSTEM, INC. has sponsored the creation of one or more 401k plans.

Company Name: FAUQUIER HEALTH SYSTEM, INC.

Employer identification number (EIN): 541416705

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAUQUIER HEALTH RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 KATY REEVES
001 2014-01-01 KATY REEVES
001 2013-01-01 KATY REEVES
001 2012-01-01 KATY REEVES KATY REEVES 2013-10-15
001 2011-01-01 KATY REEVES
001 2009-01-01 KATY REEVES

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2014-01-01	KATY REEVES
001	2014-01-01	KATY REEVES
001	2013-01-01	KATY REEVES
001	2012-01-01	KATY REEVES	KATY REEVES	2013-10-15
001	2011-01-01	KATY REEVES
001	2009-01-01	KATY REEVES

Plan Statistics for FAUQUIER HEALTH RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for FAUQUIER HEALTH RETIREMENT SAVINGS PLAN

Measure Date Value
2014: FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,870
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,597
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,259
Number of retired or separated participants receiving benefits 2013-01-01 16
Number of other retired or separated participants entitled to future benefits 2013-01-01 592
Total of all active and inactive participants 2013-01-01 1,867
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 3
Total participants 2013-01-01 1,870
Number of participants with account balances 2013-01-01 1,870
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,423
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,334
Number of retired or separated participants receiving benefits 2012-01-01 12
Number of other retired or separated participants entitled to future benefits 2012-01-01 249
Total of all active and inactive participants 2012-01-01 1,595
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 2
Total participants 2012-01-01 1,597
Number of participants with account balances 2012-01-01 1,243
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 67
2011: FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,319
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,235
Number of retired or separated participants receiving benefits 2011-01-01 1
Number of other retired or separated participants entitled to future benefits 2011-01-01 185
Total of all active and inactive participants 2011-01-01 1,421
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 2
Total participants 2011-01-01 1,423
Number of participants with account balances 2011-01-01 1,110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 52
2009: FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,328
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,159
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 465
Total of all active and inactive participants 2009-01-01 1,624
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 1,624
Number of participants with account balances 2009-01-01 1,426
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 80

Measure	Date	Value
2014: FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,870
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,597
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,259
Number of retired or separated participants receiving benefits	2013-01-01	16
Number of other retired or separated participants entitled to future benefits	2013-01-01	592
Total of all active and inactive participants	2013-01-01	1,867
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	3
Total participants	2013-01-01	1,870
Number of participants with account balances	2013-01-01	1,870
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,423
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,334
Number of retired or separated participants receiving benefits	2012-01-01	12
Number of other retired or separated participants entitled to future benefits	2012-01-01	249
Total of all active and inactive participants	2012-01-01	1,595
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	2
Total participants	2012-01-01	1,597
Number of participants with account balances	2012-01-01	1,243
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	67
2011: FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,319
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,235
Number of retired or separated participants receiving benefits	2011-01-01	1
Number of other retired or separated participants entitled to future benefits	2011-01-01	185
Total of all active and inactive participants	2011-01-01	1,421
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	2
Total participants	2011-01-01	1,423
Number of participants with account balances	2011-01-01	1,110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	52
2009: FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,328
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,159
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	465
Total of all active and inactive participants	2009-01-01	1,624
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	1,624
Number of participants with account balances	2009-01-01	1,426
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	80

Financial Data on FAUQUIER HEALTH RETIREMENT SAVINGS PLAN

Measure	Date	Value
2014 : FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-06-04	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-04	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-04	$0
Total income from all sources (including contributions)	2014-06-04	$173,478
Total loss/gain on sale of assets	2014-06-04	$0
Total of all expenses incurred	2014-06-04	$14,911,704
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-06-04	$14,794,104
Expenses. Certain deemed distributions of participant loans	2014-06-04	$117,569
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-06-04	$0
Value of total assets at end of year	2014-06-04	$0
Value of total assets at beginning of year	2014-06-04	$14,738,226
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-06-04	$31
Total interest from all sources	2014-06-04	$157,374
Total dividends received (eg from common stock, registered investment company shares)	2014-06-04	$12,660
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-06-04	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2014-06-04	$0
Total dividends received from registered investment company shares (eg mutual funds)	2014-06-04	$12,660
Was this plan covered by a fidelity bond	2014-06-04	Yes
Value of fidelity bond cover	2014-06-04	$500,000
If this is an individual account plan, was there a blackout period	2014-06-04	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-06-04	$0
Were there any nonexempt tranactions with any party-in-interest	2014-06-04	No
Contributions received from participants	2014-06-04	$0
Participant contributions at end of year	2014-06-04	$0
Participant contributions at beginning of year	2014-06-04	$54,850
Income. Received or receivable in cash from other sources (including rollovers)	2014-06-04	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-06-04	No
Value of net income/loss	2014-06-04	$-14,738,226
Value of net assets at end of year (total assets less liabilities)	2014-06-04	$0
Value of net assets at beginning of year (total assets less liabilities)	2014-06-04	$14,738,226
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-06-04	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-06-04	No
Were any leases to which the plan was party in default or uncollectible	2014-06-04	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-06-04	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-06-04	$10,998,249
Interest on participant loans	2014-06-04	$798
Interest earned on other investments	2014-06-04	$156,576
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-06-04	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-06-04	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-06-04	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-06-04	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-06-04	$3,685,127
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-06-04	$3,444
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-06-04	No
Was there a failure to transmit to the plan any participant contributions	2014-06-04	No
Has the plan failed to provide any benefit when due under the plan	2014-06-04	No
Contributions received in cash from employer	2014-06-04	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-06-04	$14,794,104
Contract administrator fees	2014-06-04	$31
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-06-04	Yes
Did the plan have assets held for investment	2014-06-04	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	2014-06-04	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-06-04	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-06-04	Yes
Opinion of an independent qualified public accountant for this plan	2014-06-04	Disclaimer
Accountancy firm name	2014-06-04	DIXON HUGHES GOODMAN'
Accountancy firm EIN	2014-06-04	520747981
2013 : FAUQUIER HEALTH RETIREMENT SAVINGS 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	$6,591,013
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$17,421,920
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$17,325,276
Expenses. Certain deemed distributions of participant loans	2013-12-31	$51,362
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$2,318,598
Value of total assets at end of year	2013-12-31	$14,738,226
Value of total assets at beginning of year	2013-12-31	$25,569,133
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$45,282
Total interest from all sources	2013-12-31	$110,839
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$664,703
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2013-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$664,703
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$4,200,000
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
Participant contributions at end of year	2013-12-31	$54,850
Participant contributions at beginning of year	2013-12-31	$247,859
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	$-10,830,907
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$14,738,226
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$25,569,133
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
Investment advisory and management fees	2013-12-31	$17,779
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$10,998,249
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$19,351,304
Interest on participant loans	2013-12-31	$10,065
Interest earned on other investments	2013-12-31	$100,774
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$2,676
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$2,676
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$3,685,127
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$5,967,294
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$3,496,873
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	$2,318,598
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$17,325,276
Contract administrator fees	2013-12-31	$27,503
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	DIXON HUGHES GOODMAN'
Accountancy firm EIN	2013-12-31	520747981
2012 : FAUQUIER HEALTH RETIREMENT SAVINGS 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	$21,628
Total income from all sources (including contributions)	2012-12-31	$4,754,947
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$1,168,702
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$1,097,321
Expenses. Certain deemed distributions of participant loans	2012-12-31	$48,977
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$2,622,293
Value of total assets at end of year	2012-12-31	$25,569,133
Value of total assets at beginning of year	2012-12-31	$22,004,516
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$22,404
Total interest from all sources	2012-12-31	$135,366
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$657,384
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$657,384
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$4,200,000
If this is an individual account plan, was there a blackout period	2012-12-31	Yes
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
Participant contributions at end of year	2012-12-31	$247,859
Participant contributions at beginning of year	2012-12-31	$242,972
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$21,297
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$21,628
Total non interest bearing cash at beginning of year	2012-12-31	$8,099
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	$3,586,245
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$25,569,133
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$21,982,888
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
Investment advisory and management fees	2012-12-31	$5,336
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$19,351,304
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$13,246,764
Interest on participant loans	2012-12-31	$10,468
Interest earned on other investments	2012-12-31	$124,889
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$2,676
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$9,542
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$9,542
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$9
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$5,967,294
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$8,475,842
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$1,339,904
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	$2,622,293
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$1,097,321
Contract administrator fees	2012-12-31	$17,068
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	Yes
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	COHEN RUTHERFORD AND KNIGHT
Accountancy firm EIN	2012-12-31	521202280
2011 : FAUQUIER HEALTH RETIREMENT SAVINGS 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	$21,628
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$30,156
Total income from all sources (including contributions)	2011-12-31	$315,207
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$1,341,829
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,339,048
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$491,300
Value of total assets at end of year	2011-12-31	$22,004,516
Value of total assets at beginning of year	2011-12-31	$23,039,666
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$2,781
Total interest from all sources	2011-12-31	$197,391
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$264,092
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$264,092
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$4,200,000
If this is an individual account plan, was there a blackout period	2011-12-31	Yes
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
Participant contributions at end of year	2011-12-31	$242,972
Participant contributions at beginning of year	2011-12-31	$328,607
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$21,297
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$36,276
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$21,628
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$30,156
Total non interest bearing cash at end of year	2011-12-31	$8,099
Total non interest bearing cash at beginning of year	2011-12-31	$8,098
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	$-1,026,622
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$21,982,888
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$23,009,510
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 registered invesment companies (eg mutual funds) at end of year	2011-12-31	$13,246,764
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$13,845,911
Interest on participant loans	2011-12-31	$12,145
Interest earned on other investments	2011-12-31	$185,236
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$9,542
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$112,645
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$112,645
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$10
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$8,475,842
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$8,708,129
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-637,576
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
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	$491,300
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,339,048
Contract administrator fees	2011-12-31	$2,781
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	Yes
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	COHEN RUTHERFORD AND KNIGHT
Accountancy firm EIN	2011-12-31	521202280
2010 : FAUQUIER HEALTH RETIREMENT SAVINGS 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	$30,156
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$610,100
Total income from all sources (including contributions)	2010-12-31	$3,512,409
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$1,547,063
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,544,619
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$1,389,037
Value of total assets at end of year	2010-12-31	$23,039,666
Value of total assets at beginning of year	2010-12-31	$21,654,264
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$2,444
Total interest from all sources	2010-12-31	$276,494
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$324,382
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$324,382
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$4,200,000
If this is an individual account plan, was there a blackout period	2010-12-31	Yes
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
Participant contributions at end of year	2010-12-31	$328,607
Participant contributions at beginning of year	2010-12-31	$312,165
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$36,276
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$38,259
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$30,156
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$610,100
Total non interest bearing cash at end of year	2010-12-31	$8,098
Total non interest bearing cash at beginning of year	2010-12-31	$8,098
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	$1,965,346
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$23,009,510
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$21,044,164
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 registered invesment companies (eg mutual funds) at end of year	2010-12-31	$13,845,911
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$12,043,980
Interest on participant loans	2010-12-31	$14,867
Interest earned on other investments	2010-12-31	$261,619
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$112,645
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$591,745
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$591,745
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$8
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$8,708,129
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$8,660,017
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$1,522,496
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	$1,389,037
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,544,619
Contract administrator fees	2010-12-31	$2,444
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	Yes
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	COHEN RUTHERFORD AND KNIGHT
Accountancy firm EIN	2010-12-31	521202280
2009 : FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for FAUQUIER HEALTH RETIREMENT SAVINGS PLAN

2014: FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	This submission is the final filing	Yes
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: FAUQUIER HEALTH RETIREMENT SAVINGS 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: FAUQUIER HEALTH RETIREMENT SAVINGS 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: FAUQUIER HEALTH RETIREMENT SAVINGS 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: FAUQUIER HEALTH RETIREMENT SAVINGS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

892483-087

Policy instance

Insurance contract or identification number	892483-087
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-06-04
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

892483-087

Policy instance

Insurance contract or identification number	892483-087
Number of Individuals Covered	622
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

892483-087

Policy instance

Insurance contract or identification number	892483-087
Number of Individuals Covered	875
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

892483-087

Policy instance

Insurance contract or identification number	892483-087
Number of Individuals Covered	1027
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

892483-087

Policy instance

Insurance contract or identification number	892483-087
Number of Individuals Covered	1039
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

53287

Policy instance

Insurance contract or identification number	53287
Number of Individuals Covered	0
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $41
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	1
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
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Company Name:	FAUQUIER HEALTH SYSTEM, INC.
Employer identification number (EIN):	541416705
NAIC Classification:	622000
NAIC Description:	Hospitals