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FORM 5500 DATA

Savings Plan for Employees of Douglas County Incorporated

Overview

Plan Information

  • Plan Year01/01/2011 — 12/31/2011
  • Date of Plan01/01/1993
  • Net Assets as of 12/31/2011 $2,347,289
  • 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 12/31/2011

  • Active (Eligible) Participants125
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits19
  • Subtotal144
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits1
  • Total145
  • Total number of participants as of 01/01/2011148
  • Number of participants with account balances126
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested7

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 AdministratorRichard Mathews

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.
3H Controlled Group Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

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 $235,000
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 $147,998
Contributions $238,042
Cash Contributions $238,042
Cash from Employers $60,478
Cash from Participants $177,564
Others (including rollovers) $0
Noncash Contributions $0
Total Earnings on Investments $-90,044
Total Interest $164
Interest-Bearing Cash $164
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 $-90,208
Other Income $0
Expenses $147,051
Total Benefit Payments $132,717
Directly to participants or beneficiaries, including direct rollovers $132,717
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 $14,334
Professional Fees $0
Contract Administrator Fees $11,007
Investment Advisory and management fees $3,327
Other Administrative Fees $0
Net Income $947
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2011 12/31/2010 Change YOY
Total Assets $2,347,289 $2,346,342 0.04%
Total noninterest-bearing cash $1,828 $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 $0 0.0%
Interest-bearing cash $0 $0 0.0%
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 $0 0.0%
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 $2,308,197 $2,316,559 -0.36%
Value of funds held in insurance co. general account $37,264 $29,783 25.12%
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 $2,347,289 $2,346,342 0.04%

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 $382,908
Franklin Balance Sheet John Hancock USA DFE: Pooled Separate Account $280,313
Oppenheimer Developing Mkt John Hancock USA DFE: Pooled Separate Account $230,295
Washington Mutual Investors John Hancock USA DFE: Pooled Separate Account $180,193
Royce Opportunity John Hancock USA DFE: Pooled Separate Account $129,604
The Growth Fund of America John Hancock USA DFE: Pooled Separate Account $124,733
Mutual Global Discovery John Hancock USA DFE: Pooled Separate Account $115,931
Mutual Beacon John Hancock USA DFE: Pooled Separate Account $113,991
Lifestyle Aggressive John Hancock USA DFE: Pooled Separate Account $95,612
Jpm Midcap Value Fund John Hancock USA DFE: Pooled Separate Account $91,209
Money Market Fund John Hancock USA DFE: Pooled Separate Account $87,693
Energy John Hancock USA DFE: Pooled Separate Account $68,689
Lifestyle Balanced John Hancock USA DFE: Pooled Separate Account $51,134
Mid Cap Stock Fund John Hancock USA DFE: Pooled Separate Account $47,175
Davis New York Venture John Hancock USA DFE: Pooled Separate Account $33,520
T. Rowe Price Equity Inc John Hancock USA DFE: Pooled Separate Account $31,816
Capital Appreciation Fund John Hancock USA DFE: Pooled Separate Account $31,688
Lifestyle Growth John Hancock USA DFE: Pooled Separate Account $29,375
Investment Company of America John Hancock USA DFE: Pooled Separate Account $29,197
T. Rowe Price Sci & Tech John Hancock USA DFE: Pooled Separate Account $25,533
Pimco Total Return John Hancock USA DFE: Pooled Separate Account $22,785
T. Rowe Price Health Sci John Hancock USA DFE: Pooled Separate Account $18,405
500 Index Fund John Hancock USA DFE: Pooled Separate Account $18,250
Domini Social Equity John Hancock USA DFE: Pooled Separate Account $17,321
Blue Chip Growth Fund John Hancock USA DFE: Pooled Separate Account $13,917
Franklin Small-Mid Growth John Hancock USA DFE: Pooled Separate Account $8,001
Financial Services Fund John Hancock USA DFE: Pooled Separate Account $7,546
Europacific Growth Fund John Hancock USA DFE: Pooled Separate Account $6,877
Retirement Living At 2010 John Hancock USA DFE: Pooled Separate Account $5,991
Mid Cap Index Fund John Hancock USA DFE: Pooled Separate Account $3,287
Oppenheimer Global John Hancock USA DFE: Pooled Separate Account $2,575
All Cap Value Fund John Hancock USA DFE: Pooled Separate Account $2,125
Small Cap Growth Index John Hancock USA DFE: Pooled Separate Account $508
Total $2,308,197

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
John Hancock Life Insurance Company U.S.A 127
EIN 01-0233346
Industry Code 65838
Contract Number 61913
Contract Year 01/01/2011 — 12/31/2011
Value in General Account at Year End $37,264
Value in Separate Accounts at Year End $2,308,197
Insurance Fees and Commissions $9,496
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 $4,915 $0
Northwest Quadrant, LLC 63088 18th Street BEND, OR 97701 Investment Manager/Adviser $0 $3,327 RIA FEES
Pension Planners Northwest 71 Centennial Loop Eugene, OR 97401 Third Party Administrator $0 $1,254 TPA COMPENSATION; IRA R/O PAYMENT; OTHER ALLOWANCES
Allocated Funds
Type of Contract Unspecified
Basis of premium rates as On File With State Insurance Commissioner
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 $29,783
Additions $7,682
Contributions Deposited during the year $7,518
Dividends and credits $164
Interest credited during the year $0
Transferred from separate account $0
Other $0
Total of Balance and Additions $37,465
Deductions $201
Disbursed from fund to pay benefits or purchase annuities during the year $0
Administration charge made by carrier $201
Transferred to Separate Account $0
Other $0
Balance at the end of the current year $37,264