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Fairmont General Hospital, Inc. Employees' Pension Plan


Plan Information

  • Plan Year01/01/2015 — 02/02/2015
  • Date of Plan07/01/1972
  • Net Assets as of 02/02/2015 $0
  • Plan Number6
  • Plan Type Single Employer
  • Is the plan collectively bargained? No
  • Did the plan file for an extension of time or the DFVC Program?Yes
  • Report Description This is the final report filed for the plan. This report is for a short plan year (less than 12 months).
  • Plan Funding ArrangementInsurance Trust
  • Plan Benefit ArrangementInsurance Trust

Participant Information as of 02/02/2015

  • Active (Eligible) Participants0
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits0
  • Subtotal0
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits0
  • Total0
  • Total number of participants as of 01/01/2015798
  • Number of participants with account balances0
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested0


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

Sponsor Information

  • Address1325 Locust Avenue
  • CityFairmont
  • StateWV
  • Zip26554
  • Telephone(304) 367-7153
  • EIN31-1156960
  • Industry Code622000
  • Named AdministratorMargaret Coster

Audit Information

  • Audit StatusAudited
  • AuditorDixon Hughes Goodman LLP
  • Auditor EIN56-0747981
  • Audit Opinion Disclaimer
  • Audit TypeLimited Scope Audit

Benefits Provided Under the Plan

Code Benefit Description
2C Money purchase A pension plan, other than a target benefit plan that requires a fixed percentage of compensation to be contributed to each eligible employee.
2E Profit-sharing A defined contribution plan that allows employer discretionary contributions. These plans often contain a 401(k) feature.

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 $2,000,000
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? No
Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets? Yes
Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC? Yes
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


Income and Expense Statement

Income $-175,513
Contributions $26,379
Cash Contributions $26,379
Cash from Employers $26,379
Cash from Participants $0
Others (including rollovers) $0
Noncash Contributions $0
Total Earnings on Investments $-201,892
Total Interest $16,793
Interest-Bearing Cash $0
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $0
Interest from Other Investments $16,793
Total Dividends $3,954
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 $-222,639
Other Income $0
Expenses $345,231
Total Benefit Payments $345,231
Directly to participants or beneficiaries, including direct rollovers $345,231
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 $0
Professional Fees $0
Contract Administrator Fees $0
Investment Advisory and management fees $0
Other Administrative Fees $0
Net Income $-520,744
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $25,820,926

Asset and Liability Statement

02/02/2015 12/31/2014 Change YOY
Total Assets $0 $26,341,670 -100.00%
Total noninterest-bearing cash $0 $0 0.0%
Receivables $0 $18,516 -100.00%
Employer Contributions $0 $18,516 -100.00%
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 $0 $17,596,272 -100.00%
Value of funds held in insurance co. general account $0 $8,726,882 -100.00%
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 $0 $26,341,670 -100.00%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

There is no information on eligible indirect compensation for this plan.

Other Service Providers Receiving Direct or Indirect Compensation

Name Nature of Service Relationship to Plan Sponsor Direct Compensation Paid by Plan Indirect Compensation Paid by Plan Total Compensation
Metropolitan Life Insurance Company Recordkeeping fees Recordkeeper $1,003 $0 $1,003
Total $1,003 $0 $1,003

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.



No investments information available for this plan.

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Metropolitan Life 0
EIN 13-5581829
Industry Code 65978
Contract Number 1009614-02
Contract Year 01/01/2015 — 02/02/2015
Value in General Account at Year End $0
Value in Separate Accounts at Year End $0
Insurance Fees and Commissions $0
Persons Receiving Commissions and Fees There are no brokers listed for this plan.
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
Balance at the end of the previous year $8,726,882
Additions $28,575
Contributions Deposited during the year $3,437
Dividends and credits $0
Interest credited during the year $16,793
Transferred from separate account $0
Other $8,345
Total of Balance and Additions $8,755,457
Deductions $8,755,457
Disbursed from fund to pay benefits or purchase annuities during the year $8,753,856
Administration charge made by carrier $0
Transferred to Separate Account $1,601
Other $0
Balance at the end of the current year $0