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FORM 5500 DATA

Savings Plan for Employees of Douglas County Incorporated

Overview

Plan Information

  • Plan Year01/01/2009 — 12/31/2009
  • Date of Plan01/01/1993
  • Net Assets as of 12/31/2009 $1,908,413
  • Plan Number1
  • Plan Type Single Employer
  • Is the plan collectively bargained? No
  • Did the plan file for an extension of time or the DFVC Program?Yes
  • Plan Funding ArrangementInsurance
  • Plan Benefit ArrangementInsurance

Participant Information as of 12/31/2009

  • Active (Eligible) Participants124
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits11
  • Subtotal135
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits2
  • Total137
  • Total number of participants as of 01/01/2009144
  • Number of participants with account balances115
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested1

Expenses

  • Total Benefit Payments$0
  • Corrective Distributions$0
  • Administrative Service Providers$0
  • Other Expenses$0
  • Total Expenses$0
  • Total Transfers$0

Sponsor Information

  • AddressP.O. Box 848
  • CityWinchester
  • StateOR
  • Zip97495
  • Telephone(541) 672-5711
  • EIN93-0899201
  • Industry Code321110
  • Named AdministratorPension Planners Northwest

Plan Administrator Information

  • Administrator NameDouglas County Incorporated
  • AddressP.O. Box 848
  • CityWinchester
  • StateOR
  • Zip97495
  • Telephone(541) 672-5711
  • Administrator EIN93-0899201

Audit Information

  • Audit StatusAudited
  • AuditorWicks Emmett LLP
  • Auditor EIN93-0718861
  • Audit Opinion Disclaimer
  • Audit TypeLimited Scope Audit

Benefits Provided Under the Plan

Code Benefit Description
2E Profit-sharing A defined contribution plan that allows employer discretionary contributions. These plans often contain a 401(k) feature.
2F ERISA section 404(c) Plan This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
2G 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.
2J 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.
2K 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 contributions 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.
2S Automatic Enrollment Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
2T Participant-directed Account Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
3D 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.

Questions and Answers

Question Answer Amount
During the plan year did the employer fail to transmit to the plan any participant contributions within the time period described in 29 CFT 2510.3-102? No
Were any loans by the plan or fixed income obligations due the plan in default as of the close of plan year or classified during the year as uncollectible? Disregard participant loans secured by participant's account balance. No
Were any leases to which the plan was a party in default or classified during the year as uncollectible? No
Were there any nonexempt transactions with any party-in-interest? No
Was this plan covered by a fidelity bond? Yes $200,000
Did the plan have a loss, whether or not reimbursed by the plan's fidelity bond, that was caused by fraud or dishonesty? No
Did the plan hold any assets whose current value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan receive any noncash contributions whose value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan have assets held for investment? Yes
Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets? No
Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC? No
Has the plan failed to provide any benefit when due under the plan? No
If this is an individual account plan, was there a blackout period? No
If there was a blackout period, have you either provided the required notice or one of the exceptions to providing the notice applied under 29 CFR 2520.101-3? No

Financials

Income and Expense Statement

Income $659,801
Contributions $206,300
Cash Contributions $206,300
Cash from Employers $49,490
Cash from Participants $156,810
Others (including rollovers) $0
Noncash Contributions $0
Total Earnings on Investments $453,501
Total Interest $2,886
Interest-Bearing Cash $2,886
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $0
Interest from Other Investments $0
Total Dividends $0
Preferred Stock $0
Common Stock $0
Rents $0
Net gain (loss) on sale of assets $0
Aggregate Proceeds $0
Aggregate Carrying Amount $0
Total Unrealized Appreciation (depreciation) of assets $0
Real Estate $0
Other $0
Net investment gain (loss) from common/collective trusts $0
Net investment gain (loss) from pooled separate accounts $0
Net investment gain (loss) from master trust investment accounts $0
Net investment gain (loss) from 103-12 investment entities $0
Net investment gain (loss) from registered investment companies $450,615
Other Income $0
Expenses $191,172
Total Benefit Payments $181,088
Directly to participants or beneficiaries, including direct rollovers $181,088
To insurance carriers for the provision of benefits $0
Other Benefit Payment Fees $0
Corrective Distributions $0
Certain deemed distributions of participant loans $0
Interest expense $0
Total Administrative Expenses $10,084
Professional Fees $0
Contract Administrator Fees $10,084
Investment Advisory and management fees $0
Other Administrative Fees $0
Net Income $468,629
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2009 12/31/2008 Change YOY
Total Assets $1,908,413 $1,439,784 32.55%
Total noninterest-bearing cash $0 $0 0.0%
Receivables $0 $0 0.0%
Employer Contributions $0 $0 0.0%
Participant Contributions $0 $0 0.0%
Other Contributions $0 $0 0.0%
General Investments $0 $53,234 -100.00%
Interest-bearing cash $0 $53,234 -100.00%
U.S. Government Securities $0 $0 0.0%
Corporate Debt Instruments $0 $0 0.0%
Preferred $0 $0 0.0%
All Other $0 $0 0.0%
Corporate Stocks $0 $0 0.0%
Preferred $0 $0 0.0%
Common $0 $0 0.0%
Partnership/joint venture interests $0 $0 0.0%
Real estate (other than employer real property) $0 $0 0.0%
Loans (other than to participants) $0 $0 0.0%
Participants Loans $0 $0 0.0%
Value of interest in common/collective trusts $0 $0 0.0%
Value of interest in pooled separate accounts $0 $1,291,575 -100.00%
Value of interest in master trust investment accounts $0 $0 0.0%
Value of interest in 103-12 investment entities $0 $0 0.0%
Value of interest in registered investment companies $1,885,357 $0 0.0%
Value of funds held in insurance co. general account $23,056 $94,975 -75.72%
Other Investments $0 $0 0.0%
Employer-related Investments $0 $0 0.0%
Employer Securities $0 $0 0.0%
Employer Real Property $0 $0 0.0%
Buildings and other property used in plan operation $0 $0 0.0%
Total Liabilities $0 $0 0.0%
Benefit Claims Payable (1) $0 $0 0.0%
Operating Payables (1) $0 $0 0.0%
Acquisition Indebtedness (1) $0 $0 0.0%
Other liabilities (1) $0 $0 0.0%
Net Assets $1,908,413 $1,439,784 32.55%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

  • John Hancock Life Insurance Company

Other Service Providers Receiving Direct or Indirect Compensation

There are no service providers listed for this plan.

Indirect Compensation

There are no service providers with indirect compensation listed for this plan.

Service Providers Who Fail or Refuse to Provide Information

There are no service providers who failed or refused to provide information.

Termination Information on Accountants and Enrolled Actuaries

There is no termination information for this plan.

Investments

Investments

Name of Investment Investment Manager Type of Investment Dollar Value
American Balanced Fund John Hancock USA DFE: Pooled Separate Account $244,364
Franklin Balance Sheet John Hancock USA DFE: Pooled Separate Account $212,569
Oppenheimer Developing Mkt John Hancock USA DFE: Pooled Separate Account $206,516
Washington Mutual Investors John Hancock USA DFE: Pooled Separate Account $137,458
Lifestyle Balanced John Hancock USA DFE: Pooled Separate Account $108,442
Mutual Global Discovery John Hancock USA DFE: Pooled Separate Account $105,436
The Growth Fund of America John Hancock USA DFE: Pooled Separate Account $98,226
Mutual Beacon John Hancock USA DFE: Pooled Separate Account $90,921
Royce Opportunity John Hancock USA DFE: Pooled Separate Account $90,774
Lifestyle Aggressive John Hancock USA DFE: Pooled Separate Account $73,540
Lifestyle Growth John Hancock USA DFE: Pooled Separate Account $69,252
Jpm Midcap Value Fund John Hancock USA DFE: Pooled Separate Account $67,100
Money Market Fund John Hancock USA DFE: Pooled Separate Account $63,335
Energy John Hancock USA DFE: Pooled Separate Account $55,924
Mid Cap Stock Fund John Hancock USA DFE: Pooled Separate Account $36,841
Davis New York Venture John Hancock USA DFE: Pooled Separate Account $28,950
Jennison Growth John Hancock USA DFE: Pooled Separate Account $28,575
T. Rowe Price Equity Inc John Hancock USA DFE: Pooled Separate Account $22,441
T. Rowe Price Sci & Tech John Hancock USA DFE: Pooled Separate Account $22,436
Pimco Total Return John Hancock USA DFE: Pooled Separate Account $20,063
Investment Company of America John Hancock USA DFE: Pooled Separate Account $18,487
500 Index Fund John Hancock USA DFE: Pooled Separate Account $15,869
Domini Social Equity John Hancock USA DFE: Pooled Separate Account $15,332
Blue Chip Growth Fund John Hancock USA DFE: Pooled Separate Account $11,965
T. Rowe Price Health Sci John Hancock USA DFE: Pooled Separate Account $11,280
Davis Financial John Hancock USA DFE: Pooled Separate Account $7,519
Europacific Growth Fund John Hancock USA DFE: Pooled Separate Account $5,441
Lifecycle 2010 John Hancock USA DFE: Pooled Separate Account $5,390
Franklin Small-Mid Growth John Hancock USA DFE: Pooled Separate Account $4,944
Oppenheimer Global John Hancock USA DFE: Pooled Separate Account $2,466
Mid Cap Index Fund John Hancock USA DFE: Pooled Separate Account $1,815
All Cap Value Fund John Hancock USA DFE: Pooled Separate Account $1,293
Small Cap Growth Index John Hancock USA DFE: Pooled Separate Account $393
Total $1,885,357

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
John Hancock Life Insurance Company U.S.A 116
EIN 01-0233346
Industry Code 65838
Contract Number 61913
Contract Year 01/01/2009 — 12/31/2009
Value in General Account at Year End $23,056
Value in Separate Accounts at Year End $1,885,357
Insurance Fees and Commissions $5,442
Persons Receiving Commissions and Fees
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
Kms Financial Services, Inc. 869 NW Wall Street, Suite 204 BEND, OR 97701 Insurance Agent or Broker $4,770 $0
Pension Planners Northwest 71 Centennial Loop Eugene, OR 97401 Third Party Administrator $0 $672 TPA FEES
Allocated Funds
Type of Contract Unspecified
Basis of premium rates
Premiums paid to carrier $0
Premiums due but unpaid at the end of the year $0
If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount $0
Specify the nature of the costs
Unallocated Funds
Type of Contract Guaranteed Investment
Balance at the end of the previous year $94,975
Additions $7,834
Contributions Deposited during the year $4,949
Dividends and credits $0
Interest credited during the year $2,885
Transferred from separate account $0
Other $0
Total of Balance and Additions $102,809
Deductions $79,753
Disbursed from fund to pay benefits or purchase annuities during the year $79,234
Administration charge made by carrier $519
Transferred to Separate Account $0
Other $0
Balance at the end of the current year $23,056