401k Plan data: DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN plan

DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN 401k Plan overview

Plan Name	DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN
Plan identification number	503

DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

DMC - MEMPHIS, INC. has sponsored the creation of one or more 401k plans.

Company Name: DMC - MEMPHIS, INC.

Employer identification number (EIN): 621650705

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2012-07-01 KIM BRADY
503 2011-07-01 GLEN ROBERTS
503 2010-07-01 GLEN ROBERTS
503 2009-01-01 GLEN ROBERTS,CFO

Plan id#	Filing Submission Date	Name of Administrator
503	2012-07-01	KIM BRADY
503	2011-07-01	GLEN ROBERTS
503	2010-07-01	GLEN ROBERTS
503	2009-01-01	GLEN ROBERTS,CFO

Plan Statistics for DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN

401k plan membership statisitcs for DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN

Measure Date Value
2012: DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 334
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 0
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 0
Total of all active and inactive participants 2012-07-01 0
2011: DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 302
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 334
Total of all active and inactive participants 2011-07-01 334
2010: DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-07-01 304
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 302
Total of all active and inactive participants 2010-07-01 302
2009: DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 288
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 292
Total of all active and inactive participants 2009-01-01 292

Measure	Date	Value
2012: DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	334
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	0
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	0
Total of all active and inactive participants	2012-07-01	0
2011: DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	302
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	334
Total of all active and inactive participants	2011-07-01	334
2010: DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-07-01	304
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	302
Total of all active and inactive participants	2010-07-01	302
2009: DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	288
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	292
Total of all active and inactive participants	2009-01-01	292

Form 5500 Responses for DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN

2012: DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	Yes
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2010: DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2009: DELTA MEDICAL CENTER EMPLOYEE DENTAL PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

CD3057/CP3057

Policy instance

Insurance contract or identification number	CD3057/CP3057
Number of Individuals Covered	310
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $12,743
Total amount of fees paid to insurance company	USD $540
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $133,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,743
Amount paid for insurance broker fees	540
Additional information about fees paid to insurance broker	BONUS COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	LIPSCOMB & PITTS INSURANCE

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

CD/CP 3057

Policy instance

Insurance contract or identification number	CD/CP 3057
Number of Individuals Covered	318
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $13,223
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $145,421
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

CD/CP 3057

Policy instance

Insurance contract or identification number	CD/CP 3057
Number of Individuals Covered	302
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $12,219
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $135,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

CD/CP 3057

Policy instance

Insurance contract or identification number	CD/CP 3057
Number of Individuals Covered	299
Insurance policy start date	2009-07-01
Insurance policy end date	2010-06-30
Total amount of commissions paid to insurance broker	USD $11,238
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $126,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,238
Insurance broker organization code?	3
Insurance broker name	LIPSCOMB & PITTS INSURANCE

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Company Name:	DMC - MEMPHIS, INC.
Employer identification number (EIN):	621650705
NAIC Classification:	622000
NAIC Description:	Hospitals