401k Plan data: WAYNE MEMORIAL HOSPITAL 401(K) PLAN plan

WAYNE MEMORIAL HOSPITAL 401(K) PLAN 401k Plan overview

Plan Name	WAYNE MEMORIAL HOSPITAL 401(K) PLAN
Plan identification number	001

WAYNE MEMORIAL HOSPITAL 401(K) 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.
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.
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

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

Company Name: WAYNE MEMORIAL HOSPITAL

Employer identification number (EIN): 586011876

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WAYNE MEMORIAL HOSPITAL 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 EMMA LOU THOMPSON
001 2013-01-01 EMMA LOU THOMPSON
001 2012-01-01 EMMA LOU THOMPSON
001 2011-01-01 JOHN MCILWAIN
001 2009-01-01 GREGORY JONES GREGORY JONES 2010-10-13
001 2009-01-01 GREGORY JONES GREGORY JONES 2010-10-13

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2014-01-01	EMMA LOU THOMPSON
001	2013-01-01	EMMA LOU THOMPSON
001	2012-01-01	EMMA LOU THOMPSON
001	2011-01-01	JOHN MCILWAIN
001	2009-01-01	GREGORY JONES	GREGORY JONES	2010-10-13
001	2009-01-01	GREGORY JONES	GREGORY JONES	2010-10-13

Plan Statistics for WAYNE MEMORIAL HOSPITAL 401(K) PLAN

401k plan membership statisitcs for WAYNE MEMORIAL HOSPITAL 401(K) PLAN

Measure Date Value
2014: WAYNE MEMORIAL HOSPITAL 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 372
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 545
Number of retired or separated participants receiving benefits 2014-01-01 4
Number of other retired or separated participants entitled to future benefits 2014-01-01 33
Total of all active and inactive participants 2014-01-01 582
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 2
Total participants 2014-01-01 584
Number of participants with account balances 2014-01-01 321
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 3
2013: WAYNE MEMORIAL HOSPITAL 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 348
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 298
Number of retired or separated participants receiving benefits 2013-01-01 5
Number of other retired or separated participants entitled to future benefits 2013-01-01 42
Total of all active and inactive participants 2013-01-01 345
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 346
Number of participants with account balances 2013-01-01 331
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 9
2012: WAYNE MEMORIAL HOSPITAL 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 356
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 306
Number of retired or separated participants receiving benefits 2012-01-01 3
Number of other retired or separated participants entitled to future benefits 2012-01-01 37
Total of all active and inactive participants 2012-01-01 346
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 347
Number of participants with account balances 2012-01-01 341
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 10
2011: WAYNE MEMORIAL HOSPITAL 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 357
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 320
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 33
Total of all active and inactive participants 2011-01-01 355
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 356
Number of participants with account balances 2011-01-01 354
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 15
2009: WAYNE MEMORIAL HOSPITAL 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 454
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 404
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 48
Total of all active and inactive participants 2009-01-01 452
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 452
Number of participants with account balances 2009-01-01 362
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 9

Measure	Date	Value
2014: WAYNE MEMORIAL HOSPITAL 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	372
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	545
Number of retired or separated participants receiving benefits	2014-01-01	4
Number of other retired or separated participants entitled to future benefits	2014-01-01	33
Total of all active and inactive participants	2014-01-01	582
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	2
Total participants	2014-01-01	584
Number of participants with account balances	2014-01-01	321
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	3
2013: WAYNE MEMORIAL HOSPITAL 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	348
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	298
Number of retired or separated participants receiving benefits	2013-01-01	5
Number of other retired or separated participants entitled to future benefits	2013-01-01	42
Total of all active and inactive participants	2013-01-01	345
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	346
Number of participants with account balances	2013-01-01	331
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	9
2012: WAYNE MEMORIAL HOSPITAL 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	356
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	306
Number of retired or separated participants receiving benefits	2012-01-01	3
Number of other retired or separated participants entitled to future benefits	2012-01-01	37
Total of all active and inactive participants	2012-01-01	346
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	347
Number of participants with account balances	2012-01-01	341
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	10
2011: WAYNE MEMORIAL HOSPITAL 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	357
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	320
Number of retired or separated participants receiving benefits	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	33
Total of all active and inactive participants	2011-01-01	355
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	356
Number of participants with account balances	2011-01-01	354
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	15
2009: WAYNE MEMORIAL HOSPITAL 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	454
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	404
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	48
Total of all active and inactive participants	2009-01-01	452
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	452
Number of participants with account balances	2009-01-01	362
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	9

Financial Data on WAYNE MEMORIAL HOSPITAL 401(K) PLAN

Measure	Date	Value
2014 : WAYNE MEMORIAL HOSPITAL 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$1,789,655
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$2,927,855
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$2,883,748
Expenses. Certain deemed distributions of participant loans	2014-12-31	$24,225
Value of total corrective distributions	2014-12-31	$12,532
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$927,045
Value of total assets at end of year	2014-12-31	$18,021,338
Value of total assets at beginning of year	2014-12-31	$19,159,538
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$7,350
Total interest from all sources	2014-12-31	$353,824
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$649,432
Participant contributions at end of year	2014-12-31	$876,133
Participant contributions at beginning of year	2014-12-31	$843,404
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$504
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-1,138,200
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$18,021,338
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$19,159,538
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$7,066,280
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$7,071,759
Interest on participant loans	2014-12-31	$39,171
Interest earned on other investments	2014-12-31	$314,653
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$10,078,925
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$11,244,375
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$508,786
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$277,109
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$2,883,748
Contract administrator fees	2014-12-31	$7,350
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Qualified
Accountancy firm name	2014-12-31	DRAFFIN & TUCKER, LLP
Accountancy firm EIN	2014-12-31	580914992
2013 : WAYNE MEMORIAL HOSPITAL 401(K) 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	$2,638,344
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$1,685,022
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,622,708
Expenses. Certain deemed distributions of participant loans	2013-12-31	$43,855
Value of total corrective distributions	2013-12-31	$12,504
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$985,217
Value of total assets at end of year	2013-12-31	$19,159,538
Value of total assets at beginning of year	2013-12-31	$18,206,216
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$5,955
Total interest from all sources	2013-12-31	$377,828
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
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
Contributions received from participants	2013-12-31	$687,908
Participant contributions at end of year	2013-12-31	$843,404
Participant contributions at beginning of year	2013-12-31	$882,956
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$7,026
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	$953,322
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$19,159,538
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$18,206,216
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$7,071,759
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$5,617,885
Interest on participant loans	2013-12-31	$42,911
Interest earned on other investments	2013-12-31	$334,917
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$11,244,375
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$11,705,375
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$1,275,299
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	$290,283
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,622,708
Contract administrator fees	2013-12-31	$5,955
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	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Qualified
Accountancy firm name	2013-12-31	DRAFFIN & TUCKER LLP
Accountancy firm EIN	2013-12-31	580914992
2012 : WAYNE MEMORIAL HOSPITAL 401(K) 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	$0
Total income from all sources (including contributions)	2012-12-31	$2,222,554
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$2,244,939
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$2,234,889
Value of total corrective distributions	2012-12-31	$5,400
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$1,121,638
Value of total assets at end of year	2012-12-31	$18,206,216
Value of total assets at beginning of year	2012-12-31	$18,228,601
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$4,650
Total interest from all sources	2012-12-31	$400,186
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$600,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$787,408
Participant contributions at end of year	2012-12-31	$882,956
Participant contributions at beginning of year	2012-12-31	$1,064,582
Administrative expenses (other) incurred	2012-12-31	$4,650
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	$-22,385
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$18,206,216
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$18,228,601
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 end of year	2012-12-31	$5,617,885
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$5,047,228
Interest on participant loans	2012-12-31	$49,348
Interest earned on other investments	2012-12-31	$350,838
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$11,705,375
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$12,116,791
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$700,730
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	$334,230
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$2,234,889
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	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Qualified
Accountancy firm name	2012-12-31	DRAFFIN & TUCKER LLP
Accountancy firm EIN	2012-12-31	580914992
2011 : WAYNE MEMORIAL HOSPITAL 401(K) 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$1,658,087
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$1,644,922
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,639,883
Value of total corrective distributions	2011-12-31	$1,564
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$1,374,229
Value of total assets at end of year	2011-12-31	$18,228,601
Value of total assets at beginning of year	2011-12-31	$18,215,436
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$3,475
Total interest from all sources	2011-12-31	$408,866
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$600,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$957,286
Participant contributions at end of year	2011-12-31	$1,064,582
Participant contributions at beginning of year	2011-12-31	$905,695
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$1,334
Administrative expenses (other) incurred	2011-12-31	$3,475
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	$13,165
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$18,228,601
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$18,215,436
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	$5,047,228
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$4,568,467
Interest on participant loans	2011-12-31	$48,667
Interest earned on other investments	2011-12-31	$360,199
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$12,116,791
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$12,741,274
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-125,008
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	Yes
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	$415,609
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,639,883
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	DRAFFIN & TUCKER, LLP
Accountancy firm EIN	2011-12-31	580914992
2010 : WAYNE MEMORIAL HOSPITAL 401(K) PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$917,035
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	$1,358
Total income from all sources (including contributions)	2010-12-31	$2,915,459
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$2,327,481
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$2,319,535
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$1,141,456
Value of total assets at end of year	2010-12-31	$18,215,436
Value of total assets at beginning of year	2010-12-31	$16,711,781
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$7,946
Total interest from all sources	2010-12-31	$82,207
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$600,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$788,513
Participant contributions at end of year	2010-12-31	$905,695
Participant contributions at beginning of year	2010-12-31	$953,518
Participant contributions at end of year	2010-12-31	$0
Participant contributions at beginning of year	2010-12-31	$34,856
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$1,289
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$18,186
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$1,358
Administrative expenses (other) incurred	2010-12-31	$7,946
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	$587,978
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$18,215,436
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$16,710,423
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	$4,568,467
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$4,591,055
Value of interest in pooled separate accounts at end of year	2010-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$4,591,055
Interest on participant loans	2010-12-31	$53,401
Interest earned on other investments	2010-12-31	$28,806
Value of interest in common/collective trusts at end of year	2010-12-31	$0
Value of interest in common/collective trusts at beginning of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$12,741,274
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$11,099,204
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$95,642
Net investment gain/loss from pooled separate accounts	2010-12-31	$1,596,154
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	Yes
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	$351,654
Employer contributions (assets) at end of year	2010-12-31	$0
Employer contributions (assets) at beginning of year	2010-12-31	$14,962
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$2,319,535
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	DRAFFIN & TUCKER, LLP
Accountancy firm EIN	2010-12-31	580914992

Form 5500 Responses for WAYNE MEMORIAL HOSPITAL 401(K) PLAN

2014: WAYNE MEMORIAL HOSPITAL 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
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
2013: WAYNE MEMORIAL HOSPITAL 401(K) 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
2012: WAYNE MEMORIAL HOSPITAL 401(K) 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
2011: WAYNE MEMORIAL HOSPITAL 401(K) 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
2009: WAYNE MEMORIAL HOSPITAL 401(K) 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

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-752156

Policy instance

Insurance contract or identification number	GA-752156
Number of Individuals Covered	282
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $21,700
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
Commission paid to Insurance Broker	USD $21,700
Insurance broker organization code?	3
Insurance broker name	EDWARD D JONES & CO

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-752156

Policy instance

Insurance contract or identification number	GA-752156
Number of Individuals Covered	331
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $21,764
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
Commission paid to Insurance Broker	USD $21,764
Insurance broker organization code?	3
Insurance broker name	EDWARD D JONES & CO

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

752126

Policy instance

Insurance contract or identification number	752126
Number of Individuals Covered	341
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $22,156
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
Commission paid to Insurance Broker	USD $22,156
Insurance broker organization code?	3
Insurance broker name	EDWARD JONES

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

752126

Policy instance

Insurance contract or identification number	752126
Number of Individuals Covered	354
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $23,488
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

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

752126

Policy instance

Insurance contract or identification number	752126
Number of Individuals Covered	452
Insurance policy start date	2010-12-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $81,578
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

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Company Name:	WAYNE MEMORIAL HOSPITAL
Employer identification number (EIN):	586011876
NAIC Classification:	622000
NAIC Description:	Hospitals