University Hospitals Form 5500 Year 2010 Employee Benefit Plan

Form 5500
DepanmBnt of ma Treasury Internal ~svenue e ~ c e s Depanmenlaf Labor Employee Benefits Secunty Admin~station Pens80n Benefit Guaranty Comai i on a8
Annual ReturnlReport of Employee Benefit Plan

This form is required to be filed for employee benefit plans under sections 104 and 4065 oithe Employee Relirement Income Security Act of 1974 (ERISA) and sections 6047(e), and 6058(a) of the Internal Revenue Code (the Code).
I Complete all entries in accordance with
OMB NOS. 1210-0110
1210-0089
2010
the instructions t o the Form 5500.
I For calendarAnnual Reportfiscal plan year beginning 0110112010 Part I I Identification Information plan year 2010 or
A
This returnlreport is for:
II
This Form is Open to Public Inspection
- a multiemployer plan; U
the first returnlreport:
1a single-employerplan;
an amended returnlreport;
and endlng - a multiple-employer plan; or U
12/31/2010
This returnlreport is:
C
D
If the plan is a collectively-bargainedplan, check here. . . . . . . . . . . . . . . . . . . . . . . Check box if filing under:
[ Form 5558;
0a short plan year returnlreport (less than 12 months). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,a

automatic extension; the DFVC program;
n u
a DFE (specify) the final returnlreport:
Part II Basic Plan lnformation-enter l a Name of plan
special extension (enter description) all requested information
1b
UNIVERSITY HOSPITALS HEALTH SYSTEM 403(B) MATCHED RETIREMENT SAVINGS PLAN
1
2a
Plan sponsor's name and address (employer, if for a single-employer plan) (Address should include room or suite no.) UNIVERSITY HOSPITALS HEALTH SYSTEM
Three-digit plan 003 number (PN) h IC Effective date of plan 0310111996
2b
Employer Identification Number (EIN) 34-0714775 number 216-844 1000
11100 EUCLID AVENUE CLEVELAND. OH 44106-6035
2d
Business code (see instructions)
Caution: A penalty for the late or incomplete filing of this returnlreport will be assessed unless reasonable cause is established. Under penalties of perjury and other penalties set forth in the instructions, I declare that I have examined this returnlreport, including accompanying schedules, statements and attachments, as well as the electronic version of this returnlreport, and to the best of my knowledge and belief, it is true, correct, and complete. SIGN Filed with aufhorizedivaiidelectronic signature HERE Signature of plan administrator SlGN HERE Signature of employerlplan sponsor Date Enter name of individual signing as employer or plan sponsor ELLIOTT KELLMAN Date Enter name of individual signing as plan administrator
Form 5500 (2010)
Page 2
3a Plan administratois name and address (if same as plan sponsor, enter 'Same')
UNIVERSITY HOSPITALS HEALTH SYSTEM 11100 EUCLiD AVENUE CLEVELAND. OH 44106~6035
3b Administrator's EiN
34-0714775
3c Administrator's telephone
number 216-844-1000
If the name andlor EIN of the plan sponsor has changed since the last returnlreport filed for this plan, enter the name, EIN and the plan number from the last returnlreport:
4b EIN 4c
34-0714775 PN 003
Sponsor's name UNiVERSlTY HOSPITALS HEALTH SYSTEM
Active participants.............................................................................................................................................................
13079
b Retired or separated participants receiving benefits............................................................................................................
6b
/i
i 40
C Other retired or separated participants entitled to future benefits..................... . ..................................................................
d Subtotal. Add lines 6a. 6b.and 6c........................
. . ........................................................................................................
6e
15310
e Deceased participantswhose beneficiaries are receiving or are entitled to receive benefits...............................................
Total. Add lines 6d and 68......................................................................................................................................................
g Number of participants Mth account balances as of the end of the plan year (only defined contribution plans complete this item) ................................................................................................................................................................
less than 100% vested........................................................................................................................................................ 6h 7 Enter the total number of employers obligated to contribute to the plan (only muitiempioyer plans complete this item) . . . . 7 8a If the plan provides pension benefits, enter the applicable pension feature codes from the List of Plan Characteristic Codes in the instructions:
h Number of participantsthat terminated employment during the plan year with accrued benefits that were
83
2L
2M 25
27
2R
b If the plan provides welfare benefits, enter the applicable welfare feature codes from the List of Plan Characteristic Codes in the instructions:
9a Plan funding arrangement (check all that apply)
10 a
9b Plan benefit arrangement (check all that apply) Insurance insurance (1) (1) X X Code section 412(e)(3) insurance contracts Code section 412(e)(3) insurance contracts (2) (2) % . Trust Trust (3) (3) General assets ofthe sponsor General assets of the sponsor (4) (4) Check all applicable boxes in 10a and l o b to indicate which schedules are attached, and, where indicated, enter the number attached. (See instructions)
Pension Schedules R (Retirement Plan infomlation) MB (Muitiempioyer Defined Benefit Plan and Certain Money (2) Purchase Plan Actuarial Information) - signed by the plan actuary
El
b General Schedules
H (Financial information) I (Financial Information Small Plan) - A (Insurance information)
(3)
(4)
SB (Single-Employer Defined Benefit Plan Actuarial informationl - sioned bv the oian actuarv
(5)
161
C (Service Provider information) D (DFEIParticipating Plan Information) G (Financial Transaction Schedules)
SCHEDULE A
(Form 5500)
D ~ p a m e nof t h e i r e s w l Internal ~ e v e n u e c servi e
Departmsnt of ~ a b o r
Insurance Information
This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERISA).
OMB No. 1210-0110
2010
b lnsurance companies are required to provide the information This Form is Open t o Public pursuant to ERISA section 103(a)(2). Inspection For calendar plan year2010 or fiscal plan year beginning 0110112010 and ending 1213112010 A Name of plan 6 Three-digit 003 UNiVERSlTY HOSPITALS HEALTH SYSTEM 403(B) MATCHED RETIREMENT SAVINGS plan number (PN) ) PLAN
I
Employee Benefits Secunb Adminirliation Pension Benefit Guaianty Cotpoation
b File as an attachment t o Form 5500.
C Plan sponsor's name as shown on line 2a of Form 5500.

UNIVERSITY HOSPITALS HEALTH SYSTEM
D Employer Identification Number (EiN)

34-0714775
Part I
lnformation Concerning lnsurance Contract Coverage, Fees, and Commissions Prov~denformat on for each contract l A on a separate Scnedu e A lndlv d ~ acontracts groupeo as a un IIn Pans II and II can oe reported on a s ngle Scned~le
1 Coverage lnformation:
(a) Name of insurance carrier
PRINCIPAL LIFE INSURANCE COMPANY (b) EIN 42-0127290 (c) NAiC code 61271 (d) Contract or identification number 439716 (e) Approximate number of persons covered at end of policy or contract year 0 Policy or contract year
(f) From
(g) To 1213112010
0110112010
2 lnsurance fee and commission information. Enterthe total fees and total commissions paid. List in item 3 the agents, brokers, and other persons in
descending order of the amount paid. (a) Total amount of commissions paid 0
(b) Total amount of fees pald 37730
Persons receiving commissions and fees. (Complete as many entries as needed to report ail persons).
(a) Name and address of the agent, broker, or other person to whom commissions or fees were paid 82 DEVONSHIRE S T . STE MClE FIDELITY INVESTMENTS TAX-EXEMPT SER BOSTON. MA 02109
(b) Amount of sales and base commissions p a ~ d 0
(c) Amount
Fees and other commissions paid (d) Purpose 37730 REFERRAU SERVICE FEE
(e) Organization code

3
(a) Name and address of the agent, broker. or other person to whom commissions or fees were paid
(b) Amount of sales and base commissions paid
Fees and other commissions paid (c) Amount

(d) Purpose
'
For Paperwork Reduction Act Notice and OM6 Control Numbers, see the instructions for Form 5500.
*..
---
-Schedule A (Form 5500) 2010 v.092308.1
Schedule A (Form 5500) 2010
Page 2
- r n
(a) Name and address of the agent, broker, or other person to whom commissions or fees were paid
(c) Amount
Fees and other commissions paid (d) Purpose
(c) Amount
(c) Amount
(c) Amount
(c) Amount
Schedule A (Form 5500) 2010
Page 3
Part II
Investment and Annuity Contract Information
Where individual contracts are provided, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this report. 4 Current value of plan's interest under this contract in the general account at year end ................................................. 4 5 Current value of plan's interest under this contract in separate accounts at year end ................................................... 5 6 Contracts With Allocated Funds: a State the basis of premium rates b
1 1
1 1
U
0
b
C
Premiums paid to carrier Premiums due but unpai If the carrier, service, or retention of the contract Specify nature of costs ) Type of contract: (1)
(3)
1 other (specify) 1
individual policies
(2)
0 group deferred annuity

.. .-
b
b
.
If contract p~rcnased. Wale or n pan to o l s l r ~ b ~benefits from a term nat ng plan check nere .n le
7 Conlracts Wilh ,naliocated F~.,ds (Do not nclude ponlons of these c ~ l r a c l s nta ned :n separate acco-nls) ma a Type of contract: (1) deposit administration (2) immediate participation guarantee (4) other b guaranteed investment (3)
fl
n 0
(3) Interest credited during the yea (4) Transferred from separate account ........................................................
(6)Total additio
d Totai of balance e Deductions:

(1) Disbursed from fund to pay benefits or purchase annuities during year (2) Administration charge made by carrier (3) Transferred to separate account (4) Other (specify below
(5) Total deductions ................................................................................................................................................ 7e(5) Balance at the end ofthe current year (subtract e(5) from d) ........................................................................... 7f
I I
1644722 16282520
Schedule A (Form 55001 2010
Paoe 4
Part Ill
Welfare Benefit Contract lnformation

If more Ulan one contract covers the same group of employees of the same employer(s) or members of the same employee organization(s), the information may be combined for reporting purposes if such contracts are experience-rated as a unit. Where contracts cover individual employees. the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this report.
8 Benefit and contract type (check ail applicable boxes) a Health (other than dental or vision) b e Temporaty disabiiity (accident and sickness) f i stop loss (large deductible) j m Other (specify) b
n n
~entai
0Long-term disabiiity
0 HMO contract
c g
isi ion
supplemental unemployment
PPO contract
d h I
Life insurance Prescription drug indemnity contract
(2) increase (decrease) in amount due but unpaid (3) Increase (decrease) i (4) Earned ((1) + (2) (3) Benefit charges (1) Claims pal
(2) Dividends or ret
a Total premiums or subscription charges paid to Carrie b if the carrier, setvice, or other organization incurred a
retention of the contract or policy, oUler than reported Specify nature of costs t
I Part IV /
Provision of lnformation
11 Did the insurance company fail to provide any information necessaly to wmpiete Schedule A? ............. 12 If the answer to line 11 is 'Yeses." specify the information not provided. )
yes
NO
SCHEDULE C
(Form 5500)
Service Provider Information
OMB NO. 1210.0110
This schedule is required to be filed under section 104 of the Employee Depanment of me ~rearury lnlsrnel R B V ~ ~ U B service Retirement Income Security Act of 1974 (ERISA). oepaitment ot Labor b File as an attachment to Form 5500. This Form i s Open t o Public Empiayse senefils secunly ~dministra~ion Inspection. pension eeoelit ~ u a i a n i cornomtion y For calendar plan year2010 or fiscal plan year beginning 0110112010 and ending 1213112010 A Name of plan B Three-digit 003 UNiVERSlTY HOSPITALS HEALTH SYSTEM 403(8) MATCHED RETiREMENT SAVINGS plan number (PN) b PLAN
2010
Plan sponsor's name as shown on line 2a of Form 5500 UNIVERSITY HOSPITALS HEALTH SYSTEM
Employer Identification Number (EIN) 34~0714775
Part I l ~ e w i c e Provider lnformation (see instructions)

reqL red for each person who recelveo d rectly or in0,reclly. 55.000 You mJSl compete ths Pan. in accoroance aith the :nslructions. l o repon the '?forn~ation or more in lolai conlpensatlon (i.e money or anytn ng else of monelary value) n connecuon wiln services rendered to Ins p an or !he pcnon's position 6% tn me plan oLr ng tne plan year t a person received only e gible ind rect compensation for h n cn tne p a n recelveo 1ne requ'red disc osures, yo. are requfreo to answer line 1 but are not required to include that person when completing the remainder of this Pad.
1 lnformation on Persons Receiving Only Eligible Indirect Compensation a Check 'Yes" or "No" to indicate whether you are excluding a person from the remainder of this Part because they received only eligible
indirect compensation for which the plan received the required disclosures (see instructions for definitions and conditions).. . . . . . . . . . . . . . . B y e s b If you answered line l a "Yes," enter the name and EIN or address of each person providing the required disciosures for the service providers who received only eligible indirect compensation. Complete as many entries as needed (see instructions). (b) Enter name and EIN or address of person who provided you disclosures on eliaible indirect ComDensation FIDELITY INVESTMENTS INST OPS. CO.
0No
04-2647786 (b) Enter name and EIN or address of person who provided you disclosure on eligible indirect compensation
(b) Enter name and EIN or address of person who provided you disclosures on eligibie indirect compensation
ib) Enter name and EIN or address of person who orovided vou disciosures on elioible indirect comoensation
For Papemork Reduction Act Notice and OM6 Control Numbers, see the instructions for Form 5500
Schedule C (Form 5500) 2010 v.092308.1
Schedule C (Form 5500) 2010
Page 2
- r n
(b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation
(b) Enter name and EIN or address of ~erson who Drovided vou disclosures on eliaible indirect comDensation
fbl Enter name and EIN or address of Derson who ~rovided disclosures on eliaible indirect comDensatlon vou
fbl Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation
Page 3
2. Information on Other Service Providers Receiving Direct or Indirect Compensation. Except for those persons for whom you
answered 'yes" to line l a above, complete as many entries as needed to list each person receiving, directly or indirectly, $5,000 or more in total compensation (i.e.. money or anything else of value) in connection with services rendered to the plan or their position with the plan during the plan year. (See instructionsl.
(a) Enter name and EIN or address (see instructions)

FIDELITY iNVESTMENTS INSTiTUTlONAL
04-2647786
Service Code(s)
(b)
Relationship to Enter direct Did service provider Did indirect compensation Enter total indirect Did the service include eligible indirect employer, employee compensation paid receive indirect compensation received by provider give you a organization, or by the plan. if none, compensation? (sources compensation, for which the service provider excluding formula instead of person known to be enter -0.. other than plan or plan plan received the required eligible indirect an amount or a party-in-interest disciosures? compensation for which you estimated amount? answered "Yes" to element (f). If none, enter -0..
(c)
(dl
(el
(f)
(9)
(h)
64 37 65 71 RECORDKEEPER 60
116681 yes
1 NO
yes
1 0
NO
0 yes
1 NO
( a ) Enter name and EIN or address (see instructions)
Service Code(s)
(b)
Relationship to Enter direct Did service provider employer, employee compensation paid receive indirect organization, or by the plan. if none, compensation? (sources person known to be enter -0.. other than plan or plan a party-in-interest sponsor)
(c)
(d)
(e)
Did indirect compensation Enter total indirect Did the service include eligible indirect compensation received by provider give you a compensation, for which the service provider exciuding formula instead of plan received the required eligible indirect an amount or compensation for which you estimated amount? disclosures? answered "Yes" to element (q. if none, enter -0..
(f)
(9)
(h)
yes
NO
yes
NO
yes
NO
Service Code@)
(b)
Relationship to Enter direct Did service provider receive indirect employer, empioyee compensation paid organization, or by the plan. if none, compensetion? (sources enter -. 0. person known to be other than plan or plan sponsor) a party-in-interest
(c)
(4
(e)
D d ~ndtrec! compensal on Enter total indirect Did the service Include e g o e and rect compensation received by provider give you z cornpenselson,for whlch the service provider excluding formula instead of plan rece ved the requlreo eligible indirect an amount or disclosures? compensation for which you estimated amount? answered 'Yes'' to element (f). if none, enter -0..
.,
(9)
(h)
Yes
NO
Yes
NO
Page 4
Service Code@)
(b)
Relationship to Enter direct Did service provider receive indirect employer, employee compensation paid organization, or by the plan. If none, compensation? (sources enter -0.. other than plan or plan person known to be sponsor) a party-in-interest
(e)
I1
Did indirect compensation Enter total indirect Did the service compensation received by provider give you E Include eligible indirect compensation, for which the service provider excluding formula instead of eligible indirect an amount or plan received the required compensation for which you estimated amount? disclosures? answered "Yes" to element (f). if none, enter -0..
(fl
(9)
Yes
0 No
Yes
NO
I
I
(9)
Service Code@)
(b)
Relationship to Enter direct Did service provider receive indirect employer, employee compensation paid organization, or by the plan. If none, compensation? (sources person known to be other than plan or pian enter -0.. a party-in-interest sponsor)
(c)
(d)
(el
Did indirect compensation Enter total indirect Did the service include eligible indirect compensation received by provider give you a compensation, for which the service provider excluding formula instead of plan received the required eligible indirect an amount or compensation for which you estimated amount? disclosures? answered 'Yes" to element (9. If none, enter -. 0.
(fl
(h)
yes
NO
yes
0 NO
yes
NO
Service Code(s)
(b)
Relationship to Enter direct Did service provider receive indirect employer, employee compensation paid organization, or by the plan, If none, compensation? (sources enter -. 0. person known to be other than plan or plan sponsor) a party-in-interest
(c)
(4
(el
Did indirect compensation Enter total indirect Did the service include eligible lndirect compensation received by provider give you a compensation, for which the service provider excluding formula instead of plan received the required eligible indirect an amount or disclosures? compensation for which you estimated amount? answered "Yes" to element (0. If none, enter -0.. yes yes
(fl
(9)
(h)
yes
0 0
NO
NO
NO
Page 5
- m
Part I /service Provider Information (continued) 3 If you reported on iine 2 receipt of indirect compensation, other than eligible indirect compensation, by a service provider, and the service provider is a fiduoiary
or provides contract administrator, consulting, custodial, investment advisory, investment management, broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1,000 or more in indirect Compensation and (b) each source for whom the service provider gave you a formula used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source.
(a) Enter service provider name as it appears on line 2

FIDELITY INVESTMENTS INSTiTUTlONAL 50
(b) Service Codes

(see instructions)
(c) Enter amount of indirect

ComDensation 0
(d) Enter name and EiN (address) of source of indirect compensation

ABF SM CAP VAL INV - BOSTON FlNANCi
(e) Describe the indirect compensation, including any

formula used to determine the service provider's eligibility lor or the amount of the indirect compensation.
u4u70

FIDELITY INVESTMENTS INSTITUTIONAL
50
(b) Service Codes

(sea instructions)

compensation 0
I
formula used to determine the service provider's eligibility for or the amount of the indirect cornpansation.
U.JtlY/o
AREL APPRECIATION - US BANCORP FUN

FIDELITY INVESTMENTS iNSTlTUTlONAL
(b) Service Codes

(see instructions)

compensation 0
(d) Enter name and EIN (address) of source of indirect compensation
I/
I
(I?) Describe the indirect compensation, including any
formula used to determine the service provider's eligibility for or the amount of the indirect compensatipn. BARON ASSET FUND - DST SYSTEMS, INC 0.40%
43-1 581814
Page 5
- r n
Part I /service Provider Information (continued)
3 If you reported on line 2 receipt of indirect compensation, other than eligible indirect compensation, by a service provider, and the service provider is a flduciaiy
or provides contract administrator, consulting, custodial, investment advisoiy, investment management, broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1,000 or more in indirect compensation and (b) each source for whom the service provider gave you a formula used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required iniormation for each source.

FIDELITY INVESTMENTS lNSTiTUTlONAL S O
(b) Service Codes

(see instructions)

com~ensation 0

GS MIDCAP VALUE INST - GOLDMAN. SAC
(e) Describe the indirect compensation, including any formula used to determine the service providets eligibility for or the amount of the indirect compensation.
U IU?O

(b) Service Codes

(see instructions)

comoensation
0
(d) Enter name and EIN (address) o i source o i indirect compensation

formula used to determine the service provider's eligibility tor or the amount oithe indirect c'ompensatioh
JANUS OVERSEAS T JANUS SERVICES L
U 34%

FIDELITY INVESTMENTS iNSTTUTlONAL
(b) Service Codes

(see instructions)

compensation
Id) Enter name and EIN faddress) of source of indirect com~ensation
JANUS WORLDWIDE T - JANUS SERVICES
fonn~la Jbeo 10 oeterm~ne Servlue provlder s elg b Illy Ine for or the amo.nl of tne ndlrect cornpensat~oo I 034%
(e) Describe the indirect com~ensation. includina anv " .
.'
Page 5
- r n
Part I l ~ e w i c e Provider Information (continued)
3 if you reported on line 2 receipt of indirect compensation, other than eligible indirect compensation, by a service provider, and the service provider is a fiduciary
or provides contract administrator, consulting, custodial, investment advisoly, investment management, broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1,000 or more in indirect compensation and (b) each source for whom the service provider gave you a formuia used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source.
(a) Enter service prov~der name as it appears on line 2

FIDELITY INVESTMENTS INSTITUTIONAL 60
(b) Service Codes

(see instructions)
( c ) Enter amount of indirect

com~ensation 0

LOOMIS BOND INST BOSTON FINANCIAL

formuia used to determine the service provider's eligibility for or the amount of the indirect compensation.
U L"?o
04-2526037

(b) Service Codes

(see instructions)

com~ensation 0

MSlF CAPITAL GRTH P - MORGAN STANLE
i
SO
formula used to determine the service provider's eligibility for or the amount of the indirect compensation.
UJb%

(b) Service Codes

(see instructions)

compensation 0

MSlF INTL REAL EST I - MORGAN STANL

formula used to determine the service provider's eligibility for or the amount of the indirect compensatipn. 0.10%
Page 5
- r n
Part I l ~ e w i c e Provider Information (continued) 3 if you reported on iine 2 receipt of indirect compensation, other than eligible indirect compensation, by a service provider, and the service provider is a fiduciary
or provides contract administrator, consulting, custodial, investment advisory, investment management, broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1,000 or more in indirect compensation and (b) each source for whom the service provider gave you a formula used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source.

FIDELITY INVESTMENTS INSTITUTIONAL 60
(b)Service Codes
(see instructions)

compensation 0

MSlF MID CAP GRTH P JPMORGAN INVE
(e) Describe the indirect compensation, including any formula used to determine the service provider's eligibility for or the amount of the indirect compensation.
U J3"lo

FiDELiTY INVESTMENTS INSTITUTIONAL
(b) Service Codes

(see instructions)

compensation 0

U 33'70
MSIF SM CO GRTH P - MORGAN STANLEY

(b) Service Codes

(see instructions)

compensation
id Describe the indirect comoensation. includina anv " .

om^
a ~ s e to determme the serv ce pro" oer b elgtuf ly d for or tne amount of the lnolrect cornpensat on
NB PARTNERS TRUST STATE STREET BA
ONE LINCOLN STREET BOSTON. MA 02111
035"/u
Page 5
- r n
Part I Isenrice Provider Information (continued)
3 if you repotied on line 2 receipt of indirect compensation, other than eligible indirect compensation, by a service provider, and the service provider is a fiduciary

60
(b) Service Codes

(see instructions)

comoensation 0

PiMCO TOT RETURN ADM - BOSTON FlNAN

U.L>~/o
I
I '1
04-2526037
I
(a) Enter service provider name as it appears on line 2 (b) Service Codes
(see instructions)

com~ensation 0
FIDELITY INVESTMENTS iNSTiTUTlONAL
I/

PIONEER GLB HI YLD A - PIONEER INVE
u 0UYo

(b) Service Codes

(see instrudions)

compensation
(dl Enter name and EiN laddress) of source of indirect compensation
(el Describe the indirect com~ensation,includina anv - . form~la used io determine the servce provider's el gibi ly {or or ine aniounl of the no'rect compensaton.
"
TEMPLETON DEV MKTS A - FRANKLIN TEM
0.35%
page 5
Part I IService Provider Information (continued)
If you reported on iine 2 receipt of indirect compensation, other then eligible indirect compensation, by a service provider, and the service provider is a fiduciary or provides contract administrator, consulting, custodial, investment advisory, investment management, broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1,000 or more in indirect compensation and (b) each source for whom the service provider qave YOU a formuia used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Comolete as manv entries as needed to report the reauired information for each source,

FIDELITY INVESTMENTS iNSTiTUTiONAL 50
(b) Service Codes

(see instructions)

compensation 0

TEMPLETON WORLD A - FRANKLIN TEMPLE

U 13, )'"
94-3167260

FIDELITY INVESTMENTS INSTITUT 50
(b) Service Codes

(see instructions)

compensation 0

formula used to determine the service provideis eligibility for or the amount of the indirect compensation.
LUY/"
RUSSELL GLOBAL REAL ESTATE SECURlTl
RUSSELL INVESTMENTS SEATTLE. WA 98101

FlDELiTY INVESTMENTS INSTITUT
(b) Service Codes

(see instructions)

compensation
(d) Enter name end EiN (address) of source of indirect compensation
I
THOMPSON PLUMB BOND FUND 918 DEMING WAY 3RD FLOOR 1 MADISON. W 53717
(e) Descr oe the and recl compensat on, nc udlng any formuia "sed to detenn ne the serv.ce prov~der's g b e for or the amount of the indirect compensation.
25%
lly
Page 5

(b) Service Codes

lsee instructions1

com~ensation 0

WESTCORE PLUS BOND FUND 1225 17TH STREET 26TH FLOOR DENVER CO 80202
(I?) Describe the indirect compensation, including any formula used to determine the service orovider's elioibilitv " , for or the amount of the indirect compensation.
.,"YO

FIDELITY INVESTMENTS INSTITUT
(b) Service Codes

(see instructions1

cornoensation 0
li
I
formula used to determine the service provider's eligibility for or the amount of the indirect comDensation. PERKINS SMALL CAP VALUE CLASS T 151 DETROIT ST DENVER CO 80206
3470

FIDELITY INVESTMENTS iNSTlTUT
(b) Service Codes

(see instructions)

compensation
(dl Enter name and EiN laddress) of source of indirect com~ensation
(el Describe the indirect com~ensation,includino anv " ,

form-ia .sed lo delennme the sew ce provloe$s el glbl ly for or tne amount of the no recl compensat on
LOOMiS SAYLES GLOBAL BOND RETAIL
399 BOYLSTON STREET. 8TH FL BOSTON. MA 021 16
35%
Schedule C (Farm 5500) 2010
Page 5
- r n
.-..,,: ., .,'.
. :
Part I /Senrice Provider information (continued) 3 if you repotied on line 2 receipt of indirect compensation, other than eligible indirect compensation, by a service provider, and the service provider is a fiduciary
or provides contract administrator, consulting, custodial, investment adviso~y,investment management, broker, or recordkeeping services, answer the following auestions for la) each source from whom the service orovider received $1.000 or more in indirect comoensation and l b l each source for whom the service provider gave'you a fomlula used to determine the indirect compensation instead oian amount or estimated amount oithe indirect compensation, Complete as manv entries as needed to reoort the reouired iniormation for each source.

FIDELITY INVESTMENTS INSTiTUT 60
(b) Service Codes

(see instructions1

com~ensation 0

AMERISTOCK MUTUAL FUND 431 NORTH PENNSYLVANIA STREET INDlANAPOLiS IN 46201

3370

FIDELITY INVESTMENTS iNSTTUT 50
(b) Service Codes

(see instructions)

compensation 0
GABELLI EQUITY INCOME FUND
3003 SUMMER STREET STAMFORD. CT 06904
(e) Describe the indirect compensation, including any formula used to determine the service provider's eligibility for or the amount of the indirect compensation. d3%

FIDELITY INVESTMENTS INSTITUT $0
(b) Service Codes

(see instructions)

compensation
[
(d) Enter name end EIN (address) of source of indirect compensation
I
PiMCO REAL RETURN CLASS D 1345 AVENUE OF THE AMERICAS 3RD FL NEW YORK. NY 10105
(e) Descr be tne ind recl compensation, .nc.udng any formLla .see to determ ne tne serv;ce provider's e ig o lily for or the amount of the indirect compensation
35%
Page 5
- D

FIDELITY INVESTMENTS INSTITUT S O
(b) Service Codes

(see instructions)

compensation 0
I
PiMCO TOTAL RETURN CLASS D 1345 AVENUE OF THE AMERICAS. 3RD FL NEWYORK NY 10105

formula used to determine the service provideis eligibility for or the amount of the indirect compensation.
337"

(b)Service Codes
(see instructions)

comoensation 0

formula used to determine the service provider's eligibility for or the amount of the indirect comDensation.
.S3"/0
GABELLI UTiLlTiES
3003 SUMMER STREET STAMFORD, CT 06904

(b) Service Codes

(see instructions)

compensation
(d) Enter name and EIN laddress) of source of indirect comoensation

HARBOR CAPITAL APPRECIATION N V CL 111 S. WACKER DR, 34TH FLOOR CHICAGO. IL 60606
I
1
formu a usen to oetermme !he service pro" der s ellg billy for or !he amount of tne ind recl compensal~on 35%
(e) Describe the indirect comoensation. inciudina anv , , " ,
Schedule C (Foml5500) 2010
Page 5
- m
or provides contract administrator, consulting, custodial, investment advisory, investment management, broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1,000 or more in indirect compensation and (b) each source ior whom the service provider gave you a formula used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source.

FIDELITY INVESTMENTS INSTTUT 50
(b) Service Codes

(see instructions)

comoensation 0

ALLIANZ NFJ LARGE VALUE FD CLASS D 1345 AVENUE OF THE AMERICAS. 3RD FL NEW YORK NY 10105
I (e) .
w
..
lncludino anv , Describe the indirect com~ensatlon. fomlula ~ s e d detetmlne lhe'serv ce pro" deis g b 111, to for or tne amount of the lndtrect cornpensallon
(a) Enter service provider name as it appears on iine 2

(b) Service Codes

(see instructions\
(e) Describe the indirect compensation, including any formula used to determine the service providets eligibility for or the amount of the indirect compensation.
4U%
HEARTLAND VALUE PLUS
789 N WATER STREET MILWAUKEE. Wi 53202

FIDELITY INVESTMENTS INSTTUT
(b) Service Codes

(see instructions)

compensation

1301 SW FIFTH AVE PORTLAND. OR 97201
(e) Describe the indirect Compensation, including any formula used to determine the service provider's eligibility for or the amount of the indirect compensation.
COLUMBIAVALUE AND RESTRUCTURING CL
Page 5
-111
.- .
Part I
--. . .
l~ervice Provider Information (continued)
3 if you reported on line 2 receipt of indirect compensation, other than eligible indirect com~ensalion.bv a service provider. and the service provider is a fiduciarv . .
0;provides contract administrator. consulting, custodial, investment ad;isory, investmeni management, broker, or recordkeeping services: answer the iollowinb questions for (a) each source from whom the service provider received $1,000 or more in indirect compensation and (b) each source for whom the service provider gave you a formula used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source.

SO
(b) Service Codes

(see instructions)

compensation 0

ULTRA SHORT SMALL CAP PRO FDS-INVST 8401 COLESVILLE ROAD STE 320 ROCKVILLE MD 20910

formula used to determine the service provider's eligibility for or the amount of the indirect comDensation.
*U',~

FIDELITY INVESTMENTS INSTITLIT 30
(b) Service Codes

(see instructions)

compensation 0

BUFFALO G R O W H FUND 615 E MICHIGAN STREET MILWAUKEE. WI 53202
(e) Descr be the ,no rect cornpensallon inc oo,ng any formula Lsed to doterm ne the serv,ce pro" der s e glo IMIY for or ttle anlodnl of tne indlrecl cornpensallon

FiDELTY INVESTMENTS INSTITUT
(b) Service Codes

(see instructions)

compensation 0

formula used to determine the service provider's eligibility for or the amount of the indirect comoensation. .40U/o
ULTRA SHORT NASDAQ- 100 PROFUND INV 8401 COLESVILLE ROAD STE 320 ROCKVILLE. MD 20910
Page 5
- r n
Part I l~ervice Provider Information (continued)
3 If you reported on line 2 receipt of Indirect compensation, other than eligible indirect compensation, by a service provider, and the service provider is a fiduciary

FIDELITY INVESTMENTS iNSTiTUT 60
(b) Service Codes

(see instructions)

comoensation 0

THIRD AVENUE FOCSED CREDIT FUND INV 622 THIRD AVENUE 32 FLOOR NEWYORK. NY 10017
' " I ~ " ,

FlDELiTY INVESTMENTS INSTITUT
(b) Service Codes

lsee instructions)

com~ensation 0

formula used to determine the service provider's eligibility for or the amount of the indirect comoensation.
.4UU/o
MATTHEWS PACIFIC TIGER FUND
4 EMBARCADERO CENTER SUiTE 550 SAN FRANCISCO CA 94111

FiDELlTY iNVESTMENTS INSTITUT 80
(b) Service Codes

(see instructions)

compensation
(
(d) Enter name and EIN (address) of source of indirect com~ensation

7250 REDWOOD BLVD., STE 200 NOVATO, CA 94945
I I
1
:ormu a use0 to delermlne the selv ce piov aer's ellglbl ly for or the amom! a! !he ind recl compensat on 40%
le) Describe the indirect comoensation. includino anv , "
HENNESSY TOTAL RETURN
Page 5
-113
Part I l ~ e w i c e Provider Information (continued) 3 If you reported on line 2 receipt of indirect compensation, other than eligible indirect compensation, by a service provider, end the service provider is a fiduciary
or provides contract administrator, consulting, custodial, investment advisory, investment management, broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1,000 or more in indirect compensation and (b) each source for whom the service provider gave you a formuia used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source.
(a) Enter setvice provider name as it appears on line 2

FIDELITY iNVESTMENTS iNSTlTUT 60
(b) Setvice Codes

(see instructions)

compensation 0
(e) Describe the ndirect compensalion, ~ n c l ~ o anyg ~n
I
MATTHEWS ASIA DiVlDEND FUND 4 EMBARCADERO CENTER SUiTE 550 SAN FRANCISCO. CA 3 11 4 1
formula Lsed to Oetermne the servcc proviaer s e:q;o. ity for or the amount oithe indirect compensation.
.' 40 "

FlDELiTY INVESTMENTS INSTITUT 50
(b) Service Codes

(see instrudions)

compensation
(e) Des~rloe lndlrect cornpensallon ncluo ng any tne forrn..la "sed lo delerm ne tne sew ce provtders e qlo lhty for or tne amount of the ndlrect compensat!on
4U%
VALUE LINE iNCOME
220 EAST 42ND STREET NEW YORK. NY 10017
(a) Enter setvice provider name as it appears on line 2

(b) Service Codes

(see instructions)

compensation

3875 EMBASSY PARKWAY AKRON, OH 44333

formula used to determine the service provider's eligibility for or the amount of the indirect comoensation. .4Oo/c
WHITE OAK SELECT G R O W H FUND
Page 5
- r n
3 If you reported on line 2 receipt of indirecl compensation, other than eligible indirect compensation, by a service provider, and the service provider is a fiduciary
or provides contract administrator, consulting, custodial, investment advisoly, investment management, broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1.000 or more in indirect compensation and (b) each source for whom the service provider gave you a formula used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source.

(b) Service Codes

(see instructions)

com~ensation 0

FMi LARGE CAP FUND
777 E WISCONSIN AVE MiLWAUKEE W153202
4"-,"

(b) Service Codes

(see instructions)

comoensation 0

formula used to determine the service provideis eligibility for or the amount of the indirect comoensation.
4u"'o
MERGER FUND
U S BANCORP FUND SERVICES. LLC MK MILWAUKEE W153202

FIDELITY iNVESTMENTS INSTiTUT 60
(b) Service Codes

(see instruclions)

compensation
C

290 WOODCLIFF DR FAIRPORT, NY 14450
I iel Describe the indirect comoensation. includino anv ,
MANNING 8 NAPIER WORLD OPPT SER CL
iom~-la~ s e lo detem ne the sen, ce pro" der's el glo ty d " for or the arnounl of the no.rec1 compensat on 40%
Page 5
-- -. ..
Part I
l ~ e ~ i Provider Information (continued) ce
or provides contract administrator, consulting, custodial, investment advisory, investment management, broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1.000 or more in indirect compensation and (b) each source for whom the service provider gave you a formula used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source.

FIDELITY INVESTMENTS INSTITLIT 60
(b) Service Codes

(see instructions)

com~ensation 0

MANNiNG R NAPER SMALL CAP SERIES 290 WOODCLIFF DR FAIRPORT, NY 14450
.4"",0

formula used to determine the service providefs eligibility for or the amount of the indirect comDensation.

(b) Service Codes

(see instr~ctions)

compensation 0
50
I
MANAGERS BOND 800 CONNECTiCUT AVE NORWALK. CT 06854
(e) Descr oc tne lnotrecl cornpensallon, InclLalng any formula ~ s e lo deteml ne fne sew ce pro<lders e lgto Illy d for or the amount of the indirect compensation:
.4UYlo

(b) Service Codes

(see instructions)
(C) Enter amount of indirect

compensation 0
(d) Enter name and EIN (address) of source of indirect campensetion
I/

formula used to determine the service provider's eligibility for or the amount of the indirect compensatipn.
FBR GAS UTILITY iNDEX
1001 NINETEENTH STREET NORTH ARLINGTON, VA 22209
40%
Page 5
Part I [serviceProvider Information (continued)
If you reported on iine 2 receipt of indirect compensation, other than eligible indirect compensation, by a service provider, and the service provider is a fiduciary or provides contract administrator, consulting, custodial, investment advisory, investment management, broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1,000 or more in indirect compensation and (b) each source for whom the service provider gave you a formula used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required iniormation for each source.

(b) Service Codes

(see instructions1

com~ensation 0

AMANA MUTUAL FUND TRUST GROWTH 1200 PROSPECT STREET SUITE 550 LAJOLLA. CA 92037
(e) Describe the indirect compensation, including any formula used to determine the service provider's eligibility for or the amount of the indirect comoensation.
.4"'/o

FiDELlTY INVESTMENTS iNSTlTUT
(b) Service Codes

(see instructions1

com~ensation 0
I
(d) Enter name and EIN (address) of source of indirect compensation (e) Describe the indirect compensation, including any
formula used to determine the service provider's eligibility for or the amount of the indirect compensation. LAZARD EMERGiNG MKTS OPEN CLASS 30 ROCKEFELLER PLAZA 57TH FL NEWYORK NY 10112
4U%

FiDELlTY INVESTMENTS INSTITUT
(b) Service Codes

(see instructions)

compensation
fd) Enter name and EiN (address1of source of indirect com~ensation

301 BATTERY STREET SUiTE 400 SAN FRANCISCO CA 9411 1
WiLLlAM BLAIR SMALL CAP GROWTH CLAS
fe) Describe the indirect com~ensation,includinu anv - . formLla used lo delerm~ne selvlce pro" oer's el glbll ly the for or the a m o m o i the and rect compensat on I 40%
.'
Page 5
- r n
Part I /service Provider lnformation (continued)
3 if vou reoorted on line 2 receiot of indirect comoensation. other than elioible indirect com~ensation. , a service omvider. and the service orovider is a fiduciarv . . . bv
or provioes consact adminst;ator conslrilng, custoolal,investment adilsory investmeni management. oroker, or recorokeeping senrces' answer the fo .ow nb quest ons for (a) each source from nhom tne service prov der received $1 000 or more n ndlrect compensation and (0) eacn source for wnom the service provoer gave you a fonndla used to determine the nndlrecl cornpensat on Instead of an amount or estimated amount of tne :ndirect compensation. Complete as lnformation for eacn so-rce many enlr.es as needed to repon the reqd~red
---
..
-.--
(a) Enter service pm,der name as t appears on Ine 2

(b) Servce Codes

(see instructions)
I (c) Enter amount of indlre:~

compensation 0

LEUTHOLD ASSET ALLOCATION FD 33 SOUTH SIXTH ST SUITE 4600 MINNEAPOLIS. MN 55402
4"0 ",

formula used to determine the service provider's eiigibilitv - . for or the amount of the indirect compensation.
~-

FiDELlTY INVESTMENTS INSTITUT
(b) Service Codes

(see instructions)

compensation
i
I
(e) Descr~be ndlrecl compensat on lnclud ng any me 'om. a dseo lo detennsne the sew ce provlder s el glbll ty for or the amount of the indirect compensation,
YACKTMAN FUND
6300 BRIDGEPOINT PARKWAY AUSTIN TX 78730

FiDELlTY INVESTMENTS INSTTUT
(b)Service Codes
lsee instructions)
I (c)
Enter amount of indirect cnmnensation 0

YACKTMAN FOCUSED FD 6300 BRIDGEPOINT PARKWAY AUSTIN. TX 78730
(e) Describe the indirect compensation, including any formula used to determine the service provider's eligibility for or the amount of the indirect cornpensatipn.
40%
page 5
- n
Part I
l~enrice Provider Information (continued)

(b) Service Codes

(see instructions)

com~ensation

NEUBERGER BERMAN PARTNERS TRUST CLA 6631 MAIN ST WILLIAMSVILLE. NY 14221
(e) Describe the indirect compensation, including any fomlula used to determine the service provider's eligibility for or the amount of the indirect compensation.
V"","

FlDELiTY INVESTMENTS iNSTlTUT S O
(b) Service Codes

(see instructions)

compensation 0
.4Ub/0
AMANA MUTUAL FUND TRUST INCOME
1200 PROSPECT STREET. SUiTE 550 LAJOLLA. CA 92037

(b) Service Codes

(see instructions)

compensation
[

ART10 INTERNATIONAL EQUITY FUND II P O BOX 4664, GRAND CENTRAL STATIO NEWYORK. NY 10163
40%
Page 5
Part I l ~ e w i c e Provider Information (continued) 3 If you repotled on line 2 receipt o i indirect comDensation, other than eligible indirect comDensation, bv a service Drovider, and the service Drovider is a fiduoiarv . .
or provides contract administrator, consulting, custodial, investment advisoly, investment management, broker, or recordkeeping services, answer the following questions for (a) each source irom whom the service provider received $1,000 or more in indirect compensation and (b) each source for whom the service provider gave you a formuia used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source.

FIDELITY INVESTMENTS iNSTlTUT 50
(b) Service Codes

(see instruciions)

compensation 0

SCOUT INTERNATIONAL FUND 3707 WEST MAPLE RD BLOOMFiELD HILLS. MI 48301

4"X

FIDELITY iNVESTMENTS INSTITUT 60
(b) Service Codes

(see instructions)

compensation 0
4U%
BUFFALO MID CAP FUND
615 E. MICHIGAN STREET MILWAUKEE. WI 53202

(b) Service Codes

(see instructions)

compensation 0

PARNASSUS WORKPLACE
ONE MARKET STREET-STEUART TOWER SUI 40% SAN FRANCISCO. CA 94105
Page 5
- r n
or provides contract administrator, consulting, custodial, investment advisory, investment management, broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1.000 or more in indirect compensation and (b) each source for whom the service provider gave you a formuia used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source.

(b) Service Codes

(see instructions)

com~ensation 0

KINETICS PARADIGM FUND
777 E WISCONSIN AVE 4TH FLOOR MILWAUKEE. Wi 53202
(e) Describe the indirect compensation, including any formula used to determine the service provider's eligibility for or the amount of the indirect comoensation.

FIDELITY INVESTMENTS INSTiTUT
(b) Service Codes

(see instructions)

compensation 0
GO
I
MANNiNG 8 NAPiER PRO BLEND EXTD CL 290 WOODCLIFF DR. FAIRPORT. NY 14450
formuia used to detetmine the setvice provider's eligibility for or the amount of the indirect compensation:
4um

FlDELlPl INVESTMENTS INSTITUT
(b) Service Codes

(see instructions)

compensation
(d) Enter name and EIN (address) of source of indirect com~ensation
WASATCH 1ST SOURCE INCOME EQUITY FU 150 SOCIAL HALL AVE SUITE 400 SALT LAKE CITY. UT 8411 1
(e) Describe the indirect com~ensation. includino anv - . formuia used to determine the'service provider's eligibility " for or the amount of the indirect compensation. 40%
Page 5
- r n
Part I [serviceProvider Information (continued) 3 If you reported on line 2 receipt of indirect compensation, other than eligible indirect compensation, by a service provider, and the service orovider is a iiduciarv
or provides contract administrator, consulting, custodial, investment ad;isoty, investmeni management, broker, or recordkeeping services; answer the following questions for (a) each source from whom the service provider received $1,000 or more in indirect compensation and (b) each source for whom the service provider gave you a formula used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source.

FIDELITY INVESTMENTS NSTITUT 30
(b) Service Codes

(see instructions)

comeensation 0

MARSICO FLEXIBLE CAPITAL FUND 803 WEST MICHIGAN STREET SUITE A MILWAUKEE. WI 53233

4U'iO

(b) Service Codes

(see instructions)

compensation 0
(e) Descrabe !he ndlrecl compensat on tncludmg any iorrnL a dseo to aelermine the serv CP provldcr s el gibi ry for or the amo-nl of the no rect compensat on
4UU/"
PRO FUNDS ULTRA SHORT MID-CAP-INV C
8401 COLESVILLE ROAD STE 320 ROCKVILLE MD 20910

(b) Service Codes

(see instructionsl

com~ensation 0

JAMES BALANCED GOLDEN RAINBOW FUND 2960 N. MERIDIAN STREET - SUiTE 300 INDIANAPOLIS. IN 46208
I/
I

formula used to determine the service provider's eligibility for or the amount of the indirect comeensation.
40%
Page 5
- m
3 If vou reoorted on iine 2 receiot of indirect camoensation, other than eliaibie indirect comoensation.. bv a service orovider. and the service Drovider is a iiduciarv . . .
or provides contract administiator, consulting, custodiai,'investment a d k o r y , investmeni management, broker, or recordkeeping services: answer the foliowini questions for (a) each source from whom the service provider received $1,000 or more in indirect compensation and (b) each source for whom the service provider gave you a formula used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required infarmation for each source.

SO
(b) service Codes

(see instructions)

comoensation 0

MARSICO ZISTCENTURY FUND 803 WEST MICHIGAN STREET SUITE A MILWAUKEE. WI 53233
1 (e) Describe the indirect compensation, including any

formula used to determine the service provider's eiigibility for or the amount of the indirect comoensation.

FIDELITY INVESTMENTS INSTiTUT
(b) Service Codes

(see instructions)

compensation 0
(e) Describe the indirect compensation, including any formula used to determine the service provider's eiigibility for or the amount of the indirect compensation.
.4UU/o
WESTPORT FUND CLASS R
253 RIVERSIDE AVE. WESTPORT, CT 06880

(b) Service Codes

lsee instructions\
1 (c)
Enter amount of indirect comoensatian

4515 PAINTERS MILL RD OWlNGS MILLS. MD 21117
(e) Describe the indirect compensation, including any formula used to determine the service provider's eiigibility for or the amount of the indirect compensatiop.
3 00
T ROWE PRICE CAP APPRECiATlON
Schedule C (Fom 5500) 2010
Page 5
- m
Part I Isemice Provider Information (continued)
3 if vou reported on line 2 receiet of indirect compensation, other than eliqible indirect compensation, bv a service orovider. end the service orovider is a fiduciarv
or.provioes contract adminst;ator, consult8ng. custoaial investment aa;lsoly .n#eslrneni management broner or recoroKeeping ans8er the :ol.ou nb questions for (a) eacn source from vrhom the rerv;ce proviaer rece:veo $1 000 or more in ndirect compensation and (b) each so-rce for whom the servce prov'oer gave you a formula used to determine the 1no.rect cornpensatton instead of an amo-nl or estmated amo-nl of the inarect cornpensaton. Complete as many entries as needed to report the required information for each source.
services'

FiDELiTY INVESTMENTS INSTITUT
I
60
(b) Service Codes

(sea instructions)
I (c) Enter amount of indirect

compensation 0

T ROWE PRICE NEWASIA 4515 PAINTERS MILL RD OWINGS MILLS. MD 21117

J UU

(b) Service Codes

(see instructions)

compensation 0
(d) Enter name end EIN (address) of source of indirect compensation
i
JUU
(e) Descr oe (he indtrect cornpensal on nclud ng any fo~mLla "sed lo determ ne tne sen, ce prov~der'sel gab. ty for or ine amount of the lndlract compensal on
T ROWE PRICE GROVflH STOCK
4515 PAINTERS MILL RD OWiNGS MILLS. MD 211 17

(b) Service Codes

(see instructions1
I (c)
I
Enter amount of indirect comoensation

4515 PAINTERS MILL RD OWINGS MILLS, MD 21 117
1
I
formula used to determine the service provider's eligibility for or the amount of the indirect comoansation. T ROWE PRICE INTL JAPAN 3.00
Page 5
- r n
Part I [service Provider Information (continued) 3 If YOU reported on line 2 receipt of indirect compensation, other than eligible indirect compensation, by a service provider, and the service provider is a fiduciary
or provides contract administrator, consulting, custodial, investment advisory, investment management, broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1,000 or more in indirect compensation and (b) each source for whom the service provider gave you a formula used to determine the indirect compensation instead o i an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source.

(b) Service Codes

(see instructions)

comoensation 0

MORGAN STANLEY MID CAP G R W H PORT C HARBORSIDE FINANCIAL CENTER PLAZA 2 JERSEY CITY NJ 07311

iormuia used to determine the service provider's eligibility for or the amount of the indirect comoensation.
UU

(b) Service Codes

(see instructions)

com~ensation 0
i
I
(e) Descr be me ind'recf cornpensallon, nc -0 ng any fornabla used to determine tne salv.ce prov~der'selig blliiy for or the amount of the indirect compensation.
SEiS8 P 500 INDEX FUND CL A
1 FREEDOM VALLEY DRIVE OAKS. PA 19456

(b) Service Codes

(see instructions)

compensation

PRIMECAP ODYSSEY AGGRESSIVE G R W H 2020 E FINANCIAL WAY. SUITE 100 GLENDORA. CA 91741 F
15.00
Page 5 .
3 If you reported on iine 2 receipt of indirect compensation, other than eligible indirect compensation, by a service provider, and the service provider is a iiduciarv
or provides contract administrator, consulting, custodial, investment advisoly, investment management, broker, or recordkeeping services; answer the foiiowin~ questions ior (a) each source from whom the service provider received $1,000 or more in indirect compensation and (b) each source for whom the service provider gave you a ionnula used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to reoorl the reouired information for each source.

FIDELITY lNVESTR4ENTS INSTITUT 30
(b) Service Codes

(see instructions)

comuensation 0

STRATTON SMALL CAP VALUE FUND 610 WEST GERMANTOWN PIKE. SUiTE 300 PLYMOUTH MEETING. PA 19462-1050
UU

FIDELITY INVESTMENTS iNSTlTUT 50
(b) Service Codes

(see instructions)

compensation 0
(d) Enter name and EiN (address) of source of indirect comuensation
COLUMBiA VALUE AND RESTRUCTURING CL
1301 SW FIFTH AVE PORTLAND OR 97201
(e) Describe the indirect comoensation. includina anv , " , 'ormLla Jseo to determine the serv ce provlaer's el gibi ty for or the of tne reel on. U I UU/0 + 7 'I UU
no compensat

(b) Service Codes

(see instructions)

compensation 0
(4)Describe the indirect compensation, including any

formula used to determine the setvice provider's eligibility for or the amount of the indirect comDensation. 0 25'/0 + 6 00
KEELEY SlVlALL CAP VALUE CLASS A
401 5 LASALLE. ST 1201 CHiCAGO iL 60605
Page 5
- m
Part I !service Provider Information (continued)
3 If vou reported on line 2 receiot of indirect compensation, other than eiiqibie indirect ComDensation. bv a service provider, and the selvice provider is a fiduciarv
aiprovtoes consact administialor, consu t ng i-stodfal, ovestment ad; sory, inveslmeni manaqemeil, broner, or recordneepng services; answer the foi o\*inb west ons for (a) eacn source from whom tne service provider recelved $1 000 or more n inorect compensation and (b) each s o m e for whom the serv:ce prov'der gave you a formu a used to determine the indirect compensation insleao of an amount or eslimaled arnoLnt of the indirect compensal'on Comp ele as many entries as needed to report the required information for each source.

(b) Service Codes

(see instructions)

c~m~en~atl~n

JOHN HANCOCK DiSClPL INED VALUE MID
601 CONGRESS ST 9TH FL BOSTON MA 02210

formula used to determine the service provider's eligibility for or the amount of the indirect compensation. u au'm I U uu
(b) Service Codes

(see instructions)

compensation
(e) Descr be !he ino rect compcnsatlon inc JO ng any formula bed lo delermlne the bervace provloer s el!glb$ltly for or lne amount of ltle lndlrecl conlpensal on
(b) Service Codes

(see instructions)

compensation

Page 6-
Part II Service Providers Who Fail or Refuse to Provide Information 4 Provide, to the extent possible, the following infomlation for each sarvice provider who failed or refused to provide the information necessarv to comDlete
this Schedule.
(a) Enter name and EiN or address of service provider (see

instructions)
(b) Nature of
Service Code@)
(c) Describe the information thet the sarvice provider failed or refused to
provide
(a) Enter name and IN or address of scru:cc prov~dor(see

instructions)
~ ( bhat-re of )
Service Code@)
(c) Dcscr be the nformafon tnat tne service provider 'a led or ref-seo to
provide
(a) Enter name and ElN or address of service provider (see

instructions)
(b) Nature of
Service Code@)
(c) Describe the information that the service provider failed or refused to
provide

instructions)
(b) Nature o i
Service Code@)
(c) Describe the information thet the service provider failed or refused to
provide

instructions)
(b) Nature of
Service Code(s)
(c) Describe the infomlation that the service provider failed or refused to
provide
(a) Enter name and ElN or address of service provider (see

instructions)
( b )Nature of
Service Code@)
(c) Describe the information that the service provider failed or reiused to
provide
Page 7
Part Ill
Termination Information on Accountants and Enrolled Actuaries (see instructions)

(complete as many entries as needed)
Address:
Explanation:
a
C
Name: Position: Address:
EIN:
e Telephone:
Explanation:
a
C
1b
EiN:
e Telephone:
Explanation:
a
C
b EIN;
e Telephone:
Explanation:
a
C
b EiN; e Telephone:
Exolanation:
(Form 5500)
Department of me Treasuw Internal Revenue s s ~ c e Dspsmeni of Labor ~mployae Benefits Security ~dmini~lation ~snsion BensfilGuaanty coipoiation
This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERISA), and section 6058(a) of the Internal Revenue Code (the Code).
2010
b Flle as an attachment to Form 5500.

and ending
For calendar plan year 2010 or fiscal plan year beginning 0110112010
This Form is Open to Public Inspection 1213112010

)
A Name of plan
UNIVERS~TY HOSPITALS HEALTH SYSTEM 403(8) MATCHED RET~REMENT SAVINGS PLAN
Three-digit plan number (PN)
003
C Plan sponsofs name as shown on line 2a of Form 5500 UNIVERSITY HOSPITALS HEALTH SYSTEM
D Employer Identification Number (EIN)

34-0714775
I Part I I Asset and Liability Statement

1
Current value of plan assets and liabilities at the beginning and end of the plan year. Combine the value of plan assets held in more than one trust. Report the value of the plan's interest in a commingled fund containing the assets oimore than one plan on a line-by-line basis unless the value is reportable on lines lc(9) through lc(14). Do not enter the value of that portion of an insurance contract which guarantees, during this plan year, to pay a specific dollar benefit at a future date. Round off amounts t o the nearest dollar. MTIAs. CCTs, PSAs, and 103.12 IEs do not complete lines 1b(1), lb(2), lc(8), lg, l h , and li.CCTs. PSAs, and 103-12 IEs also do not complete lines I d and 1a. See instructions.
Assets a Total nonlnterest-bearing cash b Receivables (less allowance for doubtful accounts):
(1) Employer contribution (2) Participant contributions (3) Othe C General investments: (1) Interest-bearingcash (include money market acoounts & certificates of deposit) ..................... ................................................................ la lb(1) lb(2) lb(3)
(a) Beginning of Year
(b)End of Year
444842 1284021 45045
385757 1345814 37493
I
lc(l) 14884289 12002093
. .
(2) U.S. Government securities
(6) All other .........................................................................................

(4) Corporate stocks (other than employer securities):
(5) Partnershipljoint venture interests

(6) Real estate (other than employer
.....................................
(7) Loans (other than to participants

(0) Value of interest in commonlcollective trust
(10) Value of interest in pooled separate accounts ....................................... (11) Value of interest in master trust investment accounts .......................... (12) Value of interest in 103-12 investment entities ............................ . ...... (13) Value of interest in registered investment companies (e.g.. mutual funds) .................................................................................... (14) Value of funds held in insurance company general account (unallocated
For Papepwork Reduction Act Notice and OM6 Control Numbers, see the instructions for Form 5500
Schedule H (Form 5500) 2010 v.092308.1
Schedule H (Form 5500) 2010
Page 2
Id
Employer-related investments: (1) (2) Employer real propert
............................................Id(1) Employersecurities ........................................

142)
e Buildings and other property used in plan operation ......................................... f Total assets (add all amounts in lines l a through l e ) .................................... Liabilities g Benefit claims payable ......................................................................................
El=$=
I k
Total liabilities
.....................................
~
(a) Beginning of Year (b) End of Year 306584730 379589480
Net Assets I Net assets (subtract line l k from line 1
II
306584730
379589480
1 Part II IIncome and Expense Statement

2 Plan income, expenses, and changes in net assets for the year. Include all lncome and expenses of the plan, including any trust(s) or separately maintained
fund@) and any paymentslreceipts tolfrom insurance carriers. Round off amounts to the nearest dollar. MTiAs, CCTs, PSAs, and 103-12 iEs do not complete lines 2a, 2b(l)(E), 2e. 2f. and 29.
Income a Contributions:
(1) Received or receivable In cash from: (A) Employers ................................ (8) Participant (C) Others (including rollovers (2) Noncash contributions Za(l)(A) 2a(l)(B) za(f)(c) 2a(2) 2a(3)
(a) Amount 10993262 36012334 5140902
(b) Total
(3) Total contributions. Add lines Za(l)(A), (B), and line Za(2) ................. (C),
52146498
b Earnings o n investments:
(1) Interest: (A) Interest-bearingcash (including money market accounts and certificates of deposit) ......................................................................... 2b(l)(A) 6192
.................................................................... (C) Corporate debt instruments ......................................................... Zb(l)(C) 2b(l)(D) (D) Loans (other than to participants) ................................................ (E) Participant loans ..................................... ............................................I 2b(l)(E) I Zb(f)(F) (F) Other ............................................................................................... (G) Total interest. Add lines Zb(l)(A) through (F) ..................................... 2b(I)(G)
""""
"
,-,
...
I I
281821 599725
.... .brmkP1 w
j
a w y h u p od i
887738 1360 6621548 6622908
(2) Dividends: (A) Preferred stock (6) Common stock (D) Total dividends. Add lines Zb(2)(A), (5). and (C)
2b(2)(A) 2b(Z)(B) 2b(2)(D) Zb(3)
(C) Registered investment company shares (e.g. mutual funds) .............. 2b(2)(C)
(3) Rent
(4) Net gain (loss) on sale of assets: (A) Aggregate proceeds ....................... 2b(4)(A) (8) Aggregate carlying amount (see instructions).................................... 2b(4)(B) (C) Subtract line 2b(4)(B) from line 2b(4)(A) and enter result .................. 2b(4)(C)
..
-.
..
!sdnIl'I
.....
.. -u - l - - .
l ~ r d r IZ 18; r
~ ~
-----.'----;---
.-.-
Page 3 (a) Amount (b) Total
2b (5) Unrealizedappreciation (depredation) of assets: (A) Real estate........................ 2b(5)(A) Zb(S)(B) (B) Other ....................... . . ............... ........................................................
(C) Total unrealized appreciation of assets. Add lines 2b(5)(A) and (B) ..................................................................
(6) Net investment gain (loss) from commonlcollectivetrusts ..........................
(7) Net investment gain (loss) from pooled separate accounts ........................
(8) Net investment gain (loss) from master trust investment accounts ............
(9) Net investment gain (loss) from 103-12 investment entities ....................... (10) Net investment gain (loss) from registered investment companies (e.g., mutual funds)...................................................................
C Other incom
d Total income. Add all income amounts in wiumn (b) and enter total...................... Expenses e Benefit payment and payments to provide benefits:
(1) Directly to participants or beneficiaries, including direct roliovers .............. 2e(l) (2) To insurance carriers for the provision of benefits...................................... 2e(Z) (3) Other ......................................................................................................... Ze(3) (4) Total benefit payments. Add lines 2e(l) through (3) ................................... 2e(4) f Corrective distributions lsee instructions) ......................................................... Zf 29 g Certain deemed distributions of participant loans (see instructions)............... 2 1 h Interest expense................................................................................................7 Zi(1) i Administrative expenses: (1) Professionalfees (2) Contract administrator fee (3) Investment advisory and management fees .......................................... (4) Othe (5) Total 2i(2) 2i(3) 2i(4)
22805010
22805010
39639
120991 120991 22965640 72654591 350159
.........................
Zi(5) 2j Zk
j Total expenses. Add all expense amounts in column (b) and enter total......... Net Income and Reconciliation k Net income (loss). Subtract line 2j from line 2 I Transfers of assets:
(1) To this plan................................
.. ..............................................................
21(1) 21(2)
(2) From this plan ............................................................................................
I Part Ill I ~ccountant'sOpinion

3
Complete lines 3a through 3c ifthe opinion of an independent qualified public accountant is attached to this Form 5500. Complete line 3d if an opinion is not attached. (1)
a The attached opinion of an independent qualified public accountant for this plan is (see instructions):
0Unqualified
(2)
0Qualified
(3)
Disclaimer
(4)
0Adverse
b Did the accountant periorm a limited scope audit pursuant to 29 CFR 2520.103-8 andlor 103-12(d)?
C Enter the name and EIN of the accountant (or accounting firm) below:
yes
NO
I11 Name:KPMG
..
121 EIN: 13-5565207 \-,

~~
d The opinion of an independent qualified public accountant is not attached because:

(1)
n This form is filed for a CCT. PSA, or MTIA.
(2)
It will be attached to the next Form 5500 pursuant to 29 CFR 2520.104-50.
Page 4
- r n
I Part IV I Compliance Questions

4
CCTs and PSAs do not complete Part IV. MTIAs, 103-12 IEs, and GiAs do not complete 4a, 4e. 4f, 4g,4h, 4k, 4m. 413, or 5. 103-12 IEs also do not complete 41 and 41. MTlAs also do not complete 41. During the plan year:
Amount
a
b
Was there a failure to transmit to the plan any participant contributions within the time period described in 29 CFR 2510.3-102? Continue to answer ''Yes" for any prior year failures until fully corrected. (See instructions and DOL's Voluntaly Fiducialy Correction Program.) ...... Were any loans oy !he plan or flxeo ~ncome gatlons dJe tne plan n defaJ t as of tne obi c ose of the plan year or classlfiea d.!r ng tne year as ~ncoilect ble? D.sregard part c pan1loans secured bv , Schedule G (Form 55001 part I if 'Yes" is I I . oarticioant's account balance. ( ~ t i a c h checked.) ................... .......................................................................................................... 4b
. .
II
. X
Were any leases to which the plan was a party in default or classified during the year as 1 uncollectible? (Attach Schedule G (Form 5500) Part I if "Yes" is checked.) .............................. Were tnere any nonexempt transact ons w l n any party-ln.lnterest? (Do no1 Inc Loe transac1,ons reported on I ne 4a A!tach Schedule G (Form 5500) Pan Ill !f 'Yes' IS checked.)................... ......................................................................................................
4,
. .
e
f
Was this plan covered by a fidelity bond? ................................................................................ Did the pian have a loss, whether or not reimbursed by the plan's fidelity bond, that was caused by fraud or dishonesty? ............................................................................................................... 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? ............................. . . ..... 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? ......... Did the plan have assets held for investment? (Attach schedule(s) of assets if Yes' is checked, and see instructions for format requirements.) .......................................................................... Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets? (Attach schedule of transactions if "Yes" is checked, and see instructions for format requirements.) ............................................................................... Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC?.........................................................................
h
i j
k
I
Has the plan failed to provide any benefit when due under the plan? ........................................ m If this is an individual account plan, was there a blackout period? (See instructions and 29 CFR 2520.101-3.) ........................ .................................................................................................... . .
n
5a
If 4m was answerea Yes,' checr. the Yes' 00%f yo^ either provioeo the req~tred nolfce or one of tne exceptons to prov dlng tne not ce app ieo Lnder 29 CFR 2520.101-3 ..................... has a reso ut~on term nale the pan been aooptm dLnng 1ne plan year or any pnor p an yea? lo if yes enter tne a m o ~ of any plan assets mat reverted to the emp oyer lnts year n transferred. (See instructions.)
Sb(l) Name of pian@)
0Yes NO
Amount:
5b if, during this plan year, any assets or liabilities were transferred from this plan to another plan@),identify the plan(s) to which assets or liabilities were
SCHEDULE R
(Form 5500)
Oepartmsnlof the Treasury
I ~ - ~ ................. ~ R~~~~~~~semirp ~ . . ~
Retirement Plan Information

I Em~lovee Retirement ,
OMB NO. 1210-0110
Depamenl of ~ a b o i Employes Benefits Sscunty Admintstration
This schedule is required to be filed under section 104 and 4065 of the Income Securitv Act of 1974 (ERISA) and section ,~ 6058(a) of the Internal ~e;enue Code (tie Code).
2010
This Form is Open to Public Inspection.
~~
~~
Pension BensfllGuaranty Corporation
I File as an attachment to Form 5500.

and ending
0110112010 For calendar plan year 2010 or fiscal plan year beginning Name of plan UNIVERSITY HOSPITALS HEALTH SYSTEM 403(B) MATCHED RETIREMENT SAVINGS PLAN
1213112010 Three-digit plan number 003
C Plan sponsor's name as shown on line 2a of Form 5500 UNIVERSITY HOSPITALS HEALTH SYSTEM
D Employer Identification Number (EIN)

34~0714775
Part I
1
Distributions
All references to distributions relate only to payments of benefits during the plan year. Total Value of distributions paid in property other than in cash or the forms of property specified in the instructions...........................................................................................................................................................
1
Enter the EIN(s) of payor@)who paid benefits on behalf of the plan to participantsor beneficiaries during the year (if more than two, enter ElNs of the two payors who paid the greatest dollar amounts of benefits): EIN(s): 04-6568107
Profit-sharing plans, ESOPs, and stock bonus plans, skip line 3.
Number of participants (living or deceased) whose benefits were distributed in a single sum, during the plan year. .................. ..................... .............. .................................
I
I
5
Part 11
4
Funding information (if the Plan 1 no! s~blecl !he m nmum Lnd na rea~iremenls section of 412 of tne internal Revenue Code or s to of , ERISA section 302, skip thispart) Is the plan administrator making an elecfion under Code section412(d)(2) OrERlSAsection 302(d)(2)?....................... Yes No NIA
I I
7 1
1 3
If the plan is a defined benefit plan, go to line 8. if a waiver of the m nfmJni f~nding slandaro for a pr or year is bang amortized .n tn s plan year, see InslrLclons and enter the oate of the r ~ l l n g eller granllng the walver Date: Month Day If you compieted iine 5, complete lines 3, 9, and 10 of Schedule ME and do not complete the remainder of this schedule. Year
a Enter the minimum required contributionfor this plan yea b Enter the amount contributed by the employer to the plan for this plan yea
C
Subtract the amount in line 6b from the amount in line 6a. Enter the result (enter a minus sign to the lefl of a negative amount
7
8
r
If you compieted iine 6c, skip lines 8 and 9. Will the minimum funding amount reported on line 6c be met by the funding deadline? .................................... If a chancte in actuarial cost method was made for this . Dian vear Dursuant to a revenue orocedure orovidino automatic approval for the change or a class ruling letter, does the plan sponsor or plaiadminlstritor agr& with the change?..................................................................................................................................................
IF==
Yes
NO
1 NIA
NIA
fl Yes
No
Part Ill
9
Amendments
Increase Decrease
I part IV
If this is a defined benefit pension plan, were any amendments adopted during this plan year that increased or decreased the value of benefits? If yes, check the appropriate box(es). If no, check the "No" box......................................................................................
fl
Both
0No
Yes Yes
ESOPs (see instructions). if this is not a plan described under Section 409(a) or 4975(e)17) of the Internal Revenue Code.
10 Were unaliocated employer securities or proceeds from the sale of unailocated securities used to repay any exempt loan?.............. 11 a Does the ESOP hold any preferred stock? ................................................................................................................................ b f the ESOP has an outstanding exempt oan w th tne employer as lenoer s such oan part of a oat<-to-oack'loang
(See ~nstrucllons defnikon of ~ack-lo-oack oan ) for
No NO
NO
.. ..... . . . . . . . . . . . . . . . . .
12 Does the ESOP hold any stock that is not readily tradable on an established securities market? ...................................................
For Paperwork Reduction Act Notice and OM6 Control Numbers, see the instructions for Form 5500.
... .................................. - .. -.-
] Yes
-- . Yes
No
Schedule R (Form 5500) 2010 v.092308.1
C ~ a rv t I Additional Information for Multiemployer Defined Benefit Pension Plans . ---... 13 Enter the to lowinq informal on for eacn employer that contr OJted more than 5% of total ContrIoJt ons to tne pan OJr ng !he plan year (measdrea in a
dollars). See insruclions. Complete as many entries as needed to report ail applicable employers. Name of contributina emplover EiN
C
b d
e
Dollar amount contributed by employer
Date collective bargaining agreement expires (If employer contributes under more than one collective bargainingagreement, check b o x 0 and see instructions regarding required attachment. Otherwise, enter the applicable date.) Month Day Year Contribution rate information (if more than one rate applies, check this box and see instructions regarding required attachment. Otherwise. compiete items 13e(l) and 13e(2).) (1) Contributionrate (in dollars and cents) (2) Base unit measure: Hourly Weekly unit of production Other (specify):
I1
a b d e
Name of contributing employer EIN

C
Date collective bargaining agreement expires (If empioyer contributes under more than one coilective bargainingagreement, check box and see instructions regardingrequired attachment Otherwise, enter the applicable date.) Month Day Year Contribution rate information (if more than one rate applies, check this box and see instructions regarding required attachment. Otherwise, complete items 13e(l) and 13e(2).) (1) Contribution rate (in dollars and cents) (2) Base unit measure: Hourly Weekly unit of production Other (specify):
I/
a b d
Name of contributing employer

EIN
Date collective bargaining agreement expires (if empioyer contributes under more than one collective bargaining agreement check box and see instructions regarding requiredattachment Otherwise, enter the applicable date.) Month Day Year Contribution rate informat~on more than one rate appiies, check this b o x 0 and see instructions regardlngrequiredattachment. Otherwise, (If complete items 13e(l) and 13e(2).) (1) Contribution rate (in dollars and cents) (2) Base unit measure: Hourly Weekly Unit of production Other (specify):
I I
I/
a b d e
Name of contributing empioyer EIN

C
Date collective bargaining agreement expires (If empioyer contributes under more than one collective bargaining agreement, check box and see instructions regarding requiredattachment otherwise, enter the applicable date.) Month Day Year Contribution rate information (if more than one rate applies, check lhis b o x 0 and see instructions regardlngrequiredattachment Otherwise, compiete Items 13e(l) and 13e(2).) (1) Contribution rate (in dollars and cents) (2) Base unit measure: Hourly Weekly Unit of production Other (specify):
/I
II
a b d e

C
Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box and see instructions regarding requiredattachment Otherwise, enter the applicable date.) Month Day Year Contribution rate information (Ifmore than one rate applies, check this b o x 0 and see instructions regardingrequired attachment. Otherwise, compiete items 13e(l) and 13e(2).) (1) Contribution rate (in dollars and cents) (2) Base unit measure: Hourly Weekly Unit of production Other (specify):
/I
/I
a b d e

C
Date collective bargaining agreement expires (if empioyer contributes undermore than one collective bargainingagreement, check box and see instructions regarding requiredattachment Otherwise, enter the applicable date.) Month Day Year
Contribution rate information (ifmore than one rate appiies, check this box and see instructions regarding required attachment Otherwise, compiete items 13e(l) and 13e(2)) (1) Contribution rate (in dollars and cents (2) Base unit measure: Houriy Unit of production Other (specify):
d m-
Schedule R (Form 5500) 2010
Page 3
14 Enter the number of participantson whose behalf no contributions were made by an employer as an employer of the
participant for:
a The current yea b The plan year immediately preceding the current plan yea
15 Enter the ratio of the number of participants under the pian on whose behalf no employer had an obligation to make an
employer contribution during the current plan year to:
a The corresponding number forthe plan year immediately preceding the current plan year ...............................
a Enter the number of employers who withdrew during the preceding plan year
17
If assets and liabilities from another plan have been transferred to or merged with this plan during the plan year, check box and see instructions regardin supplemental informationto be Included as an attachment
Part VI I Additional Information for Single-Employer and Multiemployer Defined Benefit Pension Plans 18 If any liabilities to participants or their beneficiaries under the plan as of the end of the plan year consist (in whole or in part) of liabilities to such participants
and beneficiaries under two or more pension plans as of immediately before such plan year, check box and see instructions regarding supplemental information to be included as an attachment .......................................................................................................................................................................
19 If the total number of participants is 1,000 or more, complete items (a) through (c) a Enter the percentage of plan assets held as: b
C
Stock: % Investment-Grade Debt: % High-Yield Debt: % Real Estate: Provide the average duration of the combined investment-gradeand highyield debt: 0-3 years 3-6 years 6-9 years 9-12 years 12-15 years 15-18 years
Sb Other:
018-21 years 021 years or more
What duration measure was used to calculate item 19(b)? Effective duration Macauiay duration Modified duration
Other (specify):
UNIVERSITY HOSPITALS HEALTH SYSTEM 403(b) MATCHED RETIREMENT SAVINGS PLAN
Financial Statements and Supplemental Schedule December 3 1,2010 and 2009

(With Independent Auditors' Report Thereon)
UNNERSITY HOSPITALS HEALTH SYSTEM 403(b) MATCHED RETIREMENT SAVINGS PLAN
Table of Contents
Page Independent Auditors' Report Statements of Net Assets Available for Benefits, December 31,2010 and 2009 Statements of Changes in Net Assets Available for Benefits, Years ended December 31, 2010 and 2009 Notes to Financial Statements Schedule Schedule H, Line 4i - Schedule of Assets (Held at End of Year), December 3 1,2010 All other schedules required by the Department of Labor's Rules and Regulations for Reporting and Disclosure under the Employee Retirement Income Security Act of 1974 have been omitted because there is no information to report. 3
. 4
One Cleveland Center Sulte 2600 1375 East Ninth Street Cleveland, OH 44114-1796
KPMG LLP
Independent Auditors' Report
Plan Administrator University Hospitals Health System 403(b) Matched Retirement Savings Plan: We were engaged to audit the financial statements and supplemental schedule of the University Hospitals Health System403(b) Matched Retirement Savings Plan (the Plan) as of and for the years.ended December 31, 2010 and 2009, as listed in the accompanying table of contents. These financial statements and supplemental schedule are the responsibility of the Plan's management. As permitted by 29 CFR 2520.103-8 of the Department of Labor's Rules and Regulations for Reporting and Disclosure under the Employee Retirement Income Security Act of 1974, the plan administrator instructed us not to perform, and we did not perform, any auditing procedures with respect to the information summarized in notes 3 and 4 to the financial statements, which was certified by Fidelity Management Trust Company, the trustee of the Plan, except for comparing such information to the related informatioti included in the financial statements and the supplemental schedule. We have been informed by the plan administrator that the trustee holds the Plan's investment assets and executes investment transactions. The plan administrator has obtained certifications from the trustee as of and for the years elided December 31, 2010 and 2009 that the information provided to the plan administrator by the trustee is complete and accurate. Because of the significance of the information that we did not audit, we are unable to, and do not, express an opinion on the accompanying financial statements and supplemental schedule taken as a whole. The form and content of the information included in the financial statements and supplemental schedule, other than that derived from the information certified by the trustee, have been audited by us in accordance with auditing standards generally accepted in the United States of America and, in our opinion, are presented in compliance with the Department of Labor's Rules and Regulations for Reporting and Disclosure under the Employee Retirement Income Security Act of 1974.
August 3 1,2011
KPMG LLP ir a Dalawsra limited liab8liiy psrb?anh<p. !ha U.S. member firm of KPMG lnlernsflonrl Coapenliw ('KPMO intsmslionsl), s Smsa enlify.
UNIVERSITY HOSPITALS HEALTtI SYSIE.M

403(b MATCIIED RETIREMEKT SAVINGS PLAN
Statements of Net Assets Available for Benefits December 31,2010 and 2009
Investments: Cash and cash equivalents Mutual funds Common stock Common/collective trusts Total investments Receivables: Participant loans Participant contributions Employer contributions Rollovers Total receivables Net assets available for benefits before adjustment Adjustment from fair value to contract value for interest in collective trust relating to fully benefit-responsive investment contracts Net assets available for benefits See accompanying notes to financial statements.
UNIVERSITY HOSPITALS HEALTH SYSTEM 403(b) MATCHED RETIREMENT SAVINGS PLAN Statements of Changes in Net Assets Available for Benefits Years ended December 31,2010 and 2009
Investment income: Interest and dividend income Net appreciation in fair value of investments Total investment income Contributions: Participants Employer Participant rollovers Transfers into this plan Total contributions Deductions from net assets attributed to: Benefit payments Administrative expenses Total deductions Net increase in net assets available for benefits Net assets available for benefits at beginning of year Net assets available for benefits at end of year See accompanying notes to financial statements.
22,844,649 120,991 22,965,640 72,947,541
UNIVERSITY HOSPITALS HEALTH SYSTEM 403(b) MATCHED RETIREMENT SAVINGS PLAN Notes to Financial Statements December 31,2010 and 2009
(1)
Description of Plan The following brief description of the University Hospitals Health System 403(h) Matched Retirement Savings Plan (the Plan) is provided for general information purposes only. Participants should refer to the plan agreement for more complete information.
(a)
General
The Plan became effective March 1, 1996 and is a matched defined contribution plan sponsored by University Hospitals Health System, Inc. (the System or Plan Sponsor). The Plan covers substantially all employees of the System. There are no service or age requirements of employees to participate in the Plan. The Plan is subject to the provisions of the Employee Retirement Income Security Act of 1974 (ERISA).
(b)
Employee Contributions
Each year participants may defer and contribute up to 50% of pretax annual compensation as defined in the Plan, up to the maximum allowed under the Internal Revenue Code (IRC).
(c)
Employer Contributions
The Plan Sponsor matches 50% of an eligible participant's contribution to the Plan, up to 6% of the participant's compensation. Matching employer contrihutions commence after the participant completes one year of service and has reached the age of 18.
(d)
Participant Rollovers
The Plan permits rollover contrihutions, which represent distributions from another qualified retirement plan or 457(b) plan of a former employer. The Plan may accept rollover contributions at the direction of the Plan Sponsor. Rollover contributions can be contributed from i) a trust under a qualified plan described in IRC sections 401(a) or 403(a), ii) an annuity contract described in section 403(h) of the IRC, iii) an eligible deferred compensation plan described IRC section 457(b) that is maintained by a state, political subdivision of a state, or any agency or instrumentality of a state or political subdivision of the state, or iv) an individual retirement account described in section 408(d)(3)(A)(ii) ofthe IRC. No other employee contributions are permitted.
(e)
Participant Accounts
Each participant's account is credited with the employee's and the System's contrihutions, and, investment earnings, appreciation, or depreciation in the fair value of assets. The investment balances are participant directed. Participants may change their investment options at any time. The benefit to which a participant is entitled is the benefit that can be provided from the participant's vested account.
(Continued)
UNIVERSITY HOSPITALS HEALTH SYSTEM 403(b) MATCHED RETIREMENT SAVINGS PLAN Notes to Financial Statements December 3 1,2010 and 2009
03
Vesting
Vesting in the System's contribution to the participant's account is based on a three-year cliff-vesting schedule (i.e., a participant vests in full after three years of service). Participants immediately vest in their own contributions.
(g)
Payment of Benefits
Upon termination of service, a participant will be entitled to receive the vested portion of his or her account. Benefits are recorded when paid.
(h)
Forfeitures
The forfeited balances of terminated participants' nonvested accounts (forfeiture) are used to pay administrative expenses or used to reduce future matching contributions. Forfeitures were $77,157 and $40,284 for the plan years ended December 31, 2010 and 2009, respectively.
(I)
Participant Loans
Participants may borrow from their fund accounts a minimum of $1,000 up to a maximurn amount equal to the lesser of $50,000 or 50% of their vested account balance. A participant may only have one loan outstanding at any one time. The loans are secured by the balance in the participant's account and bear interest at rates that range from 4.25% to 10.50%, which are commensurate with local prevailing rates as determined by the plan administrator. The loans have maturities of various dates through 2030. Principal and interest are repaid in equal installments over the term of the loan, with payments occurring at least quarterly. Participant loans are valued at amortized cost, which represents the unpaid principal.
0 )
Expenses
Certain administrative expenses are paid by the Plan. Certain administrative expenses, such as audit and legal fees, are paid by the Plan Sponsor.
(2)
Summary of Significant Accounting Policies
(a)
Basis of Accounting
The accompanying financial statements are prepared on the accrual basis of accounting in accordance with accounting principles generally accepted in the United States of America. Investment contracts held by a defined contribution plan are required to be reported at fair value. However, contract value is the relevant measurement attribute for that portion of the net assets available for benefits of a defined contribution plan attributable to fully benefit-responsive investment contracts because contract value is the amount participants would receive if they were to initiate permitted transactions under the terms of the Plan. The Plan invests in investment contracts through a com~non~collective trust. Contract value for this collective trust is based on the net asset value of the fund as reported by the investment advisor. The statements of net assets available for benefits present the fair value of the investment in the collective trust as well as the adjustment of the

Notes to Financial Statements December 3 1,2010 and 2009
investment in the collective trust from fair value to contract value relating to the investment contracts. The statement of changes in net assets available for benefits is prepared on a contract value basis.
(b)
Use of Estimates
The preparation of financial statements, in conformity with the accounting principles generally accepted in the United States of America, requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, and changes therein, and disclosure of contingent assets and liabilities. Actual results could differ from those estimates.
(c)
Investment Valuation and Income Recognition

Investments of the Plan are reported at fair value. Fair value is the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. See note 4 for a discussion of fair value measurements. Purchases and sales of securities are recorded on a trade-date basis. Dividends are recorded on the ex-dividend date and interest income is recorded on the accrual basis. Net appreciation (depreciation) includes the Plan's gains and losses on investments bought and sold as well as held during the year.
(3)
Investments Under the terms of a trust agreement between Fidelity Management Trust Company (the Trustee) and the Plan, the Trustee maintains a trust fund on behalf of the Plan. The participant accounts are credited with actual earnings on the underlying investments and charged for plan withdrawals. The plan administrator has elected the method of compliance permitted by 29 CFR2520.103-8 of the Department of Labor's Rules and Regulations for Reporting and Disclosure under ERISA. Accordingly, as permitted under such election, the plan administrator has obtained certifications from the Trustee of the Plan that all of the information provided by them is complete and accurate. Information included in the accompanying financial statements and su~vlementalschedule as to investments investment income. interest. and dividends, investment information il~cluded this note, and all information in the supplemental schedule, in except for participant loan information, is presented in reliance solely upon those certifications.
..
(Continued)
Notes to Financial Statements December 31,2010 and 2009
The following table presents investments as certified to be complete and accurate by the Trustee of the Plan. Individual investments representing 5% or more of the Plan's total net assets available for benefits are separately identified (*). Common/collective trusts are presented at contracted value (**).
Investments at fair value: Cash and cash equivalents Mutual funds: Fidelity Contrafund Fidelity Freedom 2020 Fidelity Freedom 2030 Fidelity Freedom 2040 Other mutual funds Common stock Common/collective trusts: Principal Fixed Account Total investments During the years ended December 31, 2010 and 2009, the investment gain and net appreciation in the Plan's investments (including investments bought, sold, and held during the year) as certified by the Trustee of the Plan were as follows:
Interest and dividend income: Cash and cash equivalents Mutual funds Common stock Common/collective trusts Participant loan interest income Total interest and dividend income Net appreciation in investments at fair value as determined by quoted market price for mutual funds Total investment income
(Continued)
UNIVERSITY IIOSPITALS HEALTH SYS'I'EM 403(b) MA'L'CHEI) RETIREMENT SAVINGS PLAN Notes to Financial Statements December 31,2010 and 2009
(4)
Fair Value Measurements The Financial Accounting Standard Board established a hierarchy for ranking the quality and reliability of the information used to determine fair values. Assets carried at fair value have been disclosed according to the following three levels: Level 1 -Unadjusted quoted prices in active markets for identical assets or liabilities. Level 1 yields the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities. A quoted price in an active market provides the most reliable evidence of fair value and shall be used to measure fair value whenever available. Level 2 -Observable inputs other than quoted prices in Level 1. Inputs such as quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar liabilities that are not active, or other inputs that are observable or can be corroborated by observable inputs. Level 3 - Unobservable inputs that are significant to the valuation of assets or liabilities and are supported by little or no market data. This includes discounted cash flow methodologies, pricing models and similar techniques that use significant unobservable inputs. Level 1 instruments consist of mutual funds, common stock and cash and cash equivalents. A mutual fund's fair value is normally calculated as of the close of business of the New York Stock Exchange. Level 2 instruments include common/collective trusts. Common/collective trusts priced daily based on a blended rate of the contracts' rate of return and the daily income earned. There are no Level 3 investments. December 31,2010 Assets: Cash and cash equivalents Mutual funds: Fixed income International Midllarge cap Small cap Other Total mutual funds Common stock Common/collective trusts Total assets
$
Level 1 12,002,093 26,179,966 23,808,883 286,698,861 5,508,894 874,704 343,071,308 35,840
Level 2
-
Level 3
Total 12,002,093 26,179,966 23,808,883 286,698,861 5,508,894 874,704 343,071,308 35,840 16,282,520 371,391,761
16,282,520 16,282,520
$ 355,109,241
(Continued)
Notes to Financial Statements December 3 1,2010 and 2009
December 31,2009
Level 1
$
Level 2
-
Level 3
-
Total
Assets: Cash and cash equivalents Mutual funds Common/collectivetrusts Total assets
(5)
14,884,289 270,939,407
$ 285,823,696
14,339,353 14,339,353
14,884,289 270,939,407 14,339,353 300,163,049
Plan Termination
Although it has not expressed any intention to do so, the System has the right under the Plan to terminate the Plan, subject to the provisions of ERISA. Participants will remain 100% vested in their accounts. (6)
Tax Status
The Plan is intended to comply with the applicable requirements of Section 403(b) of the IRC. A tax determination letter program is not yet available for IRC Section 403(b) plans through the Internal Revenue Service. The Plan administrator believes that the Plan is currently designed and being operated in compliance with applicable requirements ofthe IRC and as such is exempt from federal income taxes. The System is required to evaluate tax positions taken by the Plan and recognize a tax liability or asset if the organization has taken an uncertain position that more likely than not would be sustained upon examination by the Internal Revenue Service. The System has concluded that as of December 31, 2010, there are 110 uncertain tax positions taken or expected to be taken. The Plan is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The System believes the Plan is no longer subject to income tax examinations for years prior to 2007.
(7)
Related-Party Transactions
Certain plan investments and shares of mutual funds are managed by the Trustee of the Plan. Therefore, transactions in these mutual funds qualify as party-in-interest transactions. (8)
Risks and Uncertainties

The Plan invests in various investment securities. Investment securities are exposed to various risks such as interest rate, market, and credit risks. Due to the level of risk associated with certain investment securities, it is at least reasonably possible that changes in the values of investment securities will occur in the near term and that such changes could materially affect participants' account balances and the amounts reported in the statements of net assets available for benefits.
'
(9)
Investment Contract with Insurance Company
The Principal Fixed Account (PFA) is a general account backed stable value contract issued by the Principal Life Insurance Company. The purpose of the PFA is to provide a stable investment option with a declared interest rate, which is specific to the PFA, fully guaranteed and communicated in advance.
UNIVERSII'Y IIOSPITALS HEALTH SYSTE.M 103(b) MATCHED RETIREMENT SAVINGS PLAN
Notes to Financial Statements December 31,2010 and 2009
The PFA is comprised of guaranteed interest funds (GIF). A separate GIF is established for each defined period of time over which deposits will be accepted and each GIF has a guaranteed interest rate. Terms of the GIFs are typically established for each plan year. The composite interest rate is the blended rate of all GIF interest rates within the PFA. The composite interest rate is used for reporting purposes by the Trustee. Participant activity is accounted for at book value, thereby maintaining the liquidity desired by the participant. The guaranteed interest rate for deposits made in 2010 and 2009 were 2.75% and 3.20%, respectively. The composite interest rate for 2010 and 2009 was 3.65% and 4.10%, respectively. (10) Reconciliation to Form 5500 The following is a reconciliation of net assets available for benefits per the financial statements at December 31,2010 and 2009 to Form 5500: December 31, 2010 Net assets available for benefits per the financial statements Adjustment from contract value to fair value for fully benefit-responsive investment contracts Net assets available for benefits per Fonn 5500
$
December 31, 2009 306,679,803 95,073 306,584,730
379,627,344 37,864
379,589,480
The following is a reconciliation of investment income per the financial statements to Form 5500: December 31. Total investment income per the financial statements Adjustment from contract value to fair value for fully benefit-responsive investment contracts Total investment income per Form 5500
(11) Subsequent Events
$
December 31. 63,180,580 95,073
43,416,524 (57,209)
All activity of the Plan has been evaluated through August 3 1,201 1. There were no reportable events.
E N 340714775 Plan number: 003 Schedule H, Line 4i Schedule of Assets (Held at End of Year) December 3 1,2010
(4
(b) Identity of issue]; borrower, lessor, (a) - or similar party Description of investment, including maturity date, rate of interest, collateral, par, or maturity value Fidelity Cash and cash equivalents: 145.835.910 shares Management Fidelitv Cash Reserves ~mst?om~an~ Fidelity Cash Resrve 3,553,297.50 shares 263,825.730 shares Fidelity Govi MMKT 2,224,247.380 shares Fidelity Money Market FideliG Ret GOW MM 260.194.130 shares Fidelity Retire MMKT 818i695.370 shares Fidelity Sel Money Market 1,898,745.01 shares 494,675.160 shares Fidelity US Govi Res 2,342,578.130 shares Fidelity US Treasuly MM Total cash and cash equivalents Mutual funds: ABDN Small Cap Inst ABF Sm Cap Val Inv Ariel Appreciation Baron Asset Fund Brokeragelink ~ijelil).i3(1 L@ Cap W F~dclit? ;\>,;I hlgr 20'. Fldel~r? ,\sser .Mgr 30"" Fidelity Acsct Mgr 4O?o Fideli~). Ascer Mgr O Y o Fidelir) :\sser .\lg 6d:o 1:idcliry Assel 3lgr 70La Fidelir) Asscr Mer U Y 5o ~ideli& a l a n c e l ~ Fidelity Blue Chip Growth Fidelity Blue Chip Value Fidelity Canada Fidelity Cap Appreciation Fidelity Capital &Income Fidelity China Region Fidelity Contrafund Fidelity Convertible Sec Fidelity Corporate Bond Fidelity Disciplined Eqty Fidelity Diversified Intl Fidelity Dividend Growth Fidelity Dynamic Strat Fidelity EMEA Fidelity Emerg MrMs Fidelity Emerging Asia Fidelity Equity Income Fidelity Equity Income I1 Fidelity Europe Fidelity Europe Cap App Fidelity Exp & Multinatl Fidelity Fidelity Fidelity Fifly Fidelity Float Rt Hi Inc 3,269.476 shares 14,649.483 shares 12,959.005 shares 16,498.380 shares 57,735.308 shares 5,875.452 shares 46,121.238 shares 55,332.297 shares 5,067.146 shares 305,221.378 shares 40,015.453 shares 271,141.039 shares 43.508.405 shares (e) Current value
27.910.581 shares
297.725.709 shares
101.374.321 shares
41.915.094 shares
27.935.017 shares 8,700.985 shares 35,303.340 shares 6,473.444 shares 15,502.094 shares 27,728.001 shares (Continued)
Schedule
EIN: 340714775 Plan number: 003 Schedule H, Line 4i - Schedule of Assets (Held at End of Year) December 31.2010 (c) Description of investment, including maturity date, rate of interest, collateral, par, or maturity value Fidelitv Focused H ~ e h Inc 3.712.103 shares l.'idclilj Focused ~lt;c,cl; 8.839.824 s l ~ v r i tidelit? l k l r in On* Index 11.')75.487 share$ kidclit? 1 reeddm 20L0 153,150.116sharcs Fidelity Freedom 2005 70.270.829 shares
(b) Identity of issuer, borrower, lessor, (a) - or similar party
(4 Cost
$
(e) Current value 34.188
~idelitv Reedom 2025 ~ i d e l i Freedom 2030 6 Fidelity Reedom 2035 Fidelity Freedom 2040 Fidelity Freedom 2045 Fidelity Freedom 2050 Fidelity Freedom Income Fidelity Glb Comdty Stk Fidelity Global Balanced Fidelity GNMA Fidelity Govt Income Fidelity Gr Strategies Fidelity Growth & Income Fidelity Growth Company Fidelity Growth Discovely Fidelity High Income Fidelity Independence Fidelity lnflat Prot Bond Fidelity lnst Sh Int Govt Fidelity Intenned Bond Fidelitv lntl Cao Ao~rec . .. FideliG Intl Discove~y Fidelity Intl Enh Index Fidelity Intl Growth Fidelity Intl Real Estate Fidelity lntl Sm Cap Opp Fidelity Intl Small Cap Fidelity lntl Value Fidelity Inhn Govt Income Fidelity Invst Gr Bd Fidelity Japan Fidelity Japan Smaller Co Fidelity Large Cap Growth Fidelity Large Cap Stock Fidelity Large Cap Value Fidelity Latin America Fidelity LC Core Enh lndx Fidelity LC Gr Enh lndx Fidelity LC Val Enh Indx Fidelity Leveraged Co Stk Fidelity Low Pr Stk Fidelity Magellan Fidelity Mega Cap Stock
1.563.742.555 shares
180.348.207 shares 170;613.132 shares 122,226.176 shares 5,982.979 shares 17.117.529 shares
** ** ** ** ** ** I* ** ** ** ** ** ** ** ** ** ** **
**
**
9.710.834 shares 36,976.804 shares 1,200.919 shares 27,173.300 shares 24,992.276 shares 7,666.705 shares 24,848.820 shares 2,640.782 shares 35,235.243 shares 182,203.31 1 shares 2,894.863 shares 1,186.857 shares 24,753.340 shares 18,768.345 shares 51,563.1 12 shares 20,234.742 shares 2,844.658 shares 2,648.354 shares 1,206.517 shares 61,088.688 shares 101,167.850 shares 172,789.240 shares 39,748.597 shares
** ** ** ** ** ** ** ** ** ** **
**
** ** ** ** ** ** **
I*
I*
**
** ** **
** ** ** ** **
*I
(Continued)
EIN: 340714775 Plan nmnber: 003 Schedule H, Line 4i -Schedule of Assets (Held at End of Year) December 31, 2010 (4 Description of investment, including maturity date, rate of interest, collateral, par, or maturity value Fidelity Mid Cap Enh lndx 333.81 1 shares 28,515.652 shares Fidelity Mid Cap Growth 120,655.755 shares Fidelity Mid Cap Stock 25,816.366 shares Fidelity Mid Cap Value 9,099.583 shares Fidelity Mortgage Sec 4,526.645 shares Fidelity NASDAQ Comp lndx 56,874.685 shares Fidelity New Markets Inc Fidelitv New Millen 15.103.496 shares FideliG Nordic Fidelity OTC Portfolio Fidelity Overseas 401369.707 shares Fidelity Pacific Basin 29'4,501.112 shares Fidelity Puritan 17,520.414 shares Fidelity Real Estate Inc 29,609.199 shares Fidelity Real Estate Invs 736.136 shares Fidelity Sel Air Transprt Fidelity Sel Automotive 1,331.832 shares 10,349.173 shares Fidelity Sel Banking 4,006.360 shares Fidelity Sel Biotech Fidelity Sel Brokerage 1.414.160 shares 3i298.220 shares Fidelity Sel Chemicals Fidelity Sel Comm Equip 860.809 shares 1,120.183 shares Fidelity Sel Computers Fidelity Sel Cons Discr 245.350 shares 5,080.915 shares Fidelity Sel Cons Staples 947.483 shares Fidelity Sel ConstrIHouse Fidelity Sel Consumer Fin 1,459.157 shares Fidelity Sel Defense 3,235.881 shares Fidelity Sel Electronics 467.829 shares 20,948.770 shares Fidelity Sel Energy 8,905.103 shares Fidelity Sel Energy Svcs 2,958.556 shares Fidelity Sel Env Alt Engy Fidelity Sel Financial 2,020.743 shares Fidelity Sel Gold 29,160.049 shares 2;862.461 shares Fidelity Sel Healthcare 1,149.216 shares Fidelity Sel Indust Equip 2,434.632 shares Fidelity Sel Industrials Fidelity Sel Insurance 598.655 shares 1,552.271 shares Fidelity Sel 1T Services Fidelitv Sel Leisure 1.150.250 shares ~ideliG Materials Sel 51331.587 shares 19,216.092 shares Fidelity Sel Med Eq & Sys 2,753.967 shares Fidelity Sel Medical Del Fidelitv Sel Multimedia 654.669 shares ~ideliG Natural Gas Sel 11,638.315 shares 14,271.578shams Fidelity Sel Natural Res 14,832.430 shares Fidelity Sel Phmaceutcl 1,715.081 shares Fidelity Sel Retailing 1,772.627 shares Fidelity Sel Soflware 3,084.209 shares Fidelity Sel Technology Fidelity Sel Telecomm 969.753 shares
(b) Identity of issuer, borrower, lessor, (a) - or similar party
(4 Cost
(4 Current value
**
**
** ** ** ** ** **
** ** **
** ** **
**
** ** ** ** ** ** ** ** ** **
*'(
I*
I*
** ** ** ** **
**
I*
*I I* *I I*
** **
** **
** ** ** **
**
I*
**
I*
Schedule
BIN: 340714775 Plan number: 003 Schedule H, Line 4i - Schedule of Assets (Held at End of Year) December 31,2010 (c) Description of investment, including maturity date, rate of intercst, collateral, par, or maturity value Fidelity Sel Transport Fidelity Sel Utilities Fidelity Sel Wireless Fidelity Short Term Bond Fidelity Sm Cap Discovery Fidelity Sm Cp Enh Indx Fidelity Small Cap Growth Fidelity Small Cap Stock Fidelity Small Cap Value Fidelity Stk Sel All Cap Fidelity Stk Sel Sm Cap Fidelity Strat Div & Inc Fidelity Strat Real Ret Fidelity Strategic Incon~e Fidelity Telecom & Util Fidelity Total Bond Fidelity Total Intl Eq Fidelity Trend Fidelity Ultrashort Bond Fidelity US Bd Index Fidelity Value Fidelity Value Discovery Fidelity Value Strategies Fidelity Worldwide GS Midcap Value Inst Janus Oversens T J a ~ u Worldwide T s Loomis Bond Inst MSIF Capital Grth P MSIF Glb Franchise P MSIF Intl Real Est I MSIF Mid Cap Grth P MSIF Sm Co Grth P NB Partners Trust PIMCO Tot Return Adm Pioneer Glb Hi Yld A Spartan 500 Index Spartan Extnd MM Index Spartan Int Tr Indx Inv Spartan Intl Index Spartan Lt TI Indx Inv Spartan St Tr Indx Inv Spartan Total Mkt Index Templeton Dev Mkts A Templeton World A Vang Infl Prot Sec Total mutual fnnds 2,063.545 shares 3,039.295 shares 17,706.828 shares 28,141.567 shares 27,134.423 shares 4,436.278 shares 30,805.632 shares 66,643.873 shares 39,632.728 shares 748.107 shares 28,709.445 shares 24,760.803 shares 6,501.302 shares 115,433.600 shares 6,571.305 shares 78,207.534 shares 9,193.668 shares 2,532.932 shares 20,196.193 shares 234,616.839 shares 21,500.692 shares 18,739.859 shares 8,201.691 shares 20,876.554 shares 6,279.737 shares 80,037.519 shares 5.346 shares 29,867.446 shares 152.694 shares 5,657.332 shares 1,540.847 shares 25,828.489 shares 54,354.176 shares 13,769.239 shares 419,348.182 shares 5,510.213 shares 153,958.805 shares 11,458.464 shares 24,843.282 shares 39,555.356 shares 6,572.183 shares 6,287.381 shares 59,400.558 shares 43,143.939 shares 1,203.019 shares 61,723.588 shares
(b) Identity of issuer, borrower, lessor, (a) or similar party
(d) Cost
*I .
(4 Current value 114.362
** ** ** **
**
I*
i*
**
** **
** ** ** ** **
** ** ** ** ** ** *a ** ** ** ** ** ** ** **
** ** ** **
** ** **
I*
** **
** ** ** ** **
(Continued)
EIN: 340714775 Plan number: 003

Schedule H, Line 4i -Schedule of Assets (Held at End of Year) December 31,2010 (4 Description of investment, including maturity date, rate of interest, collateral, par, o r maturity value Comnon stock: Annaly Mortgage Management Inc. 2,000 shares Total common stock Comnon/collective trusts: Principal Fixed Account Total commonleollective trusts 14,437,995,150 shares
$
(b) Identity of issuer, borrower, icssor, (a) - o r similar party
(4 Cost
(4 Current value
**
Participant loans
Participant loans with interest rates ranging from 4.25% to 10.50% and various maturity dates through 2030 Total participant loans Total investments
** Historical cost information is not required on schedule H, line 4i - schedule of assets held (at end of year) for
participant-directed investments.
++ Cost of participant loans is $0 as indicated in the instluctions to Form 5500

Note: This schedule is based on information that has been certified as complete and accurate by Fidelity Management Trust Company, the Plan's Trustee. See accompanying independent auditors' report.
UNIVERSI I\' HOSPITALS HE.\LI'Il S1S'lXhf 403(b) ~ I ' C I I L D IU~IIIFMT.UTSAVING> PUN EIN: 340714775 Plan number: 003 Schedule K Line 4i - Schedule of Assets (Held at End of Yew) December 31.2010
(c)
Identity of issuer, borrower, lessor, (a) - or similar party
(b)
Description of investment, including maturity date, n t e of lutered, colhtenl, par, o r maturity vqlue Cash and cash equivalents Fidelity Cash Resaves Fidelity Crcsh Resrvc Fidehty Govt MMKT Fidelity Money Market F~delity Govl MM Ret Fidelity Retire MMKT Fidelitv Sel Monw Market ~ideli& G kcs US & Fidelity US Treasury MM Total cash and cash equivalents Mutual funds: ABDN Small Cap Inst ABF Sm Cap Val Inv Ariel ~ ~ ~ r r h a t i o n B m Asset Fund Bmkmelink ~idrlity? 30.30 12 Cap . Fidslip ,Isset M y 20% Fidelity hscc h l 3005 ~ I.~dclit)Arsel M p 40% ~ i d e l i Asset M% 50% c Fidelitv Asset Mer 60% ~ideli& Asset 70% Fidelity Asset Mgr 85% Fidelity Balanced Fidelity Blue Chip GmMh Fidelity Blue Chip Value Fidelity Canada Fidclity Cap Appreciation Fidelity Capital & Income Fidelity China Region Fidelity Contrafund Fidelity Convertible Sec Fidelity Caporate Bond Fidelity Disciplined Eqty Fidelity Divmified Intl Fidelity Dividend Growih Fidelity Dynamic Strat Fidelity EMEA Fidelity Emerg M&5 Fidelity Emerging Asia Fidelity Equity Income Fidelity Equity Income 11 Fidelity Europe Fidelity Eumpe Cap App Fidelity Exp & Multinatl Fidelity Fidelity Fidelity ARy Fidelity Float Rt Hi Inc 3,269.476 shares 14,649.483 shares 12,959.005 s h m 16,498.380 sham 57.735.308 shares 145,835,910sham 3,553,297 50 sham 263,825.730 shares 2,224,247 380 s h m 260,194 130 shares 818,695.370 shares 1.898.745.01 shares 494,675.160 shares 2,342,578.130 sham
(11) Cost
Fidei~ty Management Trast Company
ML
5,067.146 shares 305,221.378 shares 40.015.453 sham 27i,i41.039 sh43;508.405 sham 288,708.228 shares 265,739.910 sham 48,840,806 sham 27,910.581 sham 45,697.091 shares 136,614.507 shares 40,235.525 shares 297,725.709 shares 15,769.831 shares 10,550.353 sham 51,856.866 shares 101,374.321 shares 55,801.059 rh3,067.146 sham 7,761.355 sham 41,915.094 sham 17,860.985 s h m 91,924.616 sl~ares 26,738.766 sham 27,935.017 shares 8,700.985 sham 35,303.340 shares 6,473.444 sham 15,502,094 sham 27,728.001 shares (Continued)
EIN: 340714775 Plan number: 003 Schedule H, Line 4i - Schedule ofAsets (Held at End ofyear) December 31,2010 (c) Description of investment, including maturity date, n t c of interest, rollntcnl, par, o r ~ t ~ r iY t ~ yU B Fidelity Mid Cap Enh lndx Fidelity Mid Cap Gmwth Fidelity Mid Cap Stock Fidelity Mid Cap Value Fidelity Mortgage Sec Fidelity NASDAQ Comp lndx Fidelity New Markets Inc Rdelity New Millen Fidelity Nordic Fidelity OTC Portfolio Fidelity Overseas Fidelity Pacific Basin Fidelity Puritan Fidelity Real Estate Inc Fidelity Real Estate lnvs Fidelity Scl Air Transprt Fidelity Sel Automotive Fidelity Sd Banking Fidelity Scl Biotech Fidelity Sel Bmkaage Fidelih, Sel Chemicals FL~CII& Sel con1111Equtp Fidelit).Scl Computers 1:ldeli~ Cons Dism ScI Fid-lir) Scl Cons Sinpl<s F~dclity ConstrNoure Scl I:ld<lny Sel Cunqumer Fir) F~dehty Defense Sel Ftdeliw Sel Electronics Fidcli& Sel Energy Fidelity Sel Energy Svcs Fidelity Sel Env Alt Engy Fidelity Scl Financial Fidelity Scl Gold Fidelity Sel EIealthm Fidelity Sel Indust Equip Fidelity Sel Indushials Fidelity Set Insurance Fidclity Sel IT Services Fidelity S d Leisure Fidelity Sel Materials Fidelity Sel Med Eq & Sys Fidelity Sel Medical Dcl Fidclity Sel Multimedia Fidelity Scl Natural Gas Fidelity Sel Natttral Res Fidelitv Sel Phmnceutcl ridelit; Scl llc~a~ling I:~dci~ty SoRwxre Scl Ftdelity Sel 'I x h n u l ~ i 7 Fidelity Scl 1 elccoln~n 333.811 sham 28,515.652 shares 120,655,755 shares 25,816.366 s h w 9,099.583 shares 4,526.645 shares 56,874.685 shares 15,103.496 shares 3,819.278 shares 132,085,233shares 78,772.190 shares 40,369.707 shares 294,501,112 shares 17,520.414 s h m 29,609.199 shares 736.136 shares 1,331.832 s h w s 10,349.173 shares 4,006.360 shnres 1,414.160 shares 3.298.220 shares 8i0.809 sl~arci 1.120.183 shnrcs 2.15.350 sham 5,080.915 shares 917.483 s h a m 1,459.157 shares 3,235.881 shares 467.829 shares 20,948.770 shams 8,905.103 shares 2.958.556 shares 2,020.743 sham 29,160.049 shwcs 2,862 461 shares 1,149.216 sham 2,434.632 shares 598.655 s h a m 1,552.271 shares 1,150 250 sham 5,331.587 sham 19,216.092 shares 2,753.967 shares 654.669 sham 11,638.315 shares 14,271.578 shares 14.832.430 shares l.?1~.081slims 1.772627 r h m s 3,084 209 s h m 909 753 s1~om
~~~ ~
(b) Identity of issuer, borrower, lessor, (a) - o r similar party
\-,
(d) Cost
Current value
(Continued)
Schedule
EIN: 340714775 Plan number: 003 Schedule B, Line 4i - Schedule of Assets (Held at End of Year) December31. 2010
(C)
(b)
Identity of issuer, borruwer, lessor, or similar party
Description of investment, including maturity date, rate of interest, collateral, par, o r maturity value Fidelity Sel Transport Fidelity Sel Utilities Fidelity Scl Wireless Fidelity Short T m n Bond Fidelity Sm Cap Discovery Fidelity Sm Cp Enh lndx Fidelihi Small Can Growth ~ideli6 Small capStock Fidelity Sinall Cap Value Fidelity Stk Sel All Cap Fidelity Stk Sel Srn Cap Fidelity Strat Div & Inc Fidelity Stml Real Ret Fidelity Swategic lncome Fidelity Telecom & Util Fidelity Total Bond Fidelity Total lntl Eq Fidelity T ~ n d Fidelity Ultreshm Bond Fidelity US Bd Index Fidelity Value Fidelity Vnlue Discovery Fidelity Vnlue Strategies Fidelity Worldwide GS Midcap Value Inst Jnnus Oversee T Janus Worldwide T Laamis Bond lnst MSlF Capital Grth P MSlF Glb Franchise P MSlF Intl Real EsL I MSIF Mid Cap Grlh P MSlF Sm Co Grth P N? Partners Trust L PIMCO Tot Return Adm Pioneer Glb Hi Yld A Spartan 500 lndex Spartan Extnd Mkt lndex Spartan Int Tr Indx Inv Soartan Intl Index bart ~r~~ tan Lt Tr lndx lnv Spartan St Tr lndx lnv Spartan Tolal Mkt Indcx Templeton Dev Mkts A Templeton World A Vang Infl Pmt Scc
~ ~ ~~ ~
(c)
(d) Cost S
Curlrnt value
2,063.545 shares 3,039.295 shores 17,706.828 shares 28,141.567 shara 27,134.423 shares 4,436.278 shares 30.805.632 shares 66i643.873 shares 39,632.728 sharcs 748.107 s h a m 28,709.445 shares 24,760.803 shares 6,501.302 shares 115,433.600 shares 6,571.305 shares 78,207.534 shares 9,193.668 shares 2,532.932 shares 20;196.193 shares 234,616.839 shares 21,500.692 shares 18,739.859 shares 8,201.691 shares 20.876.554 s h m s 6,279.737 shares 80,037.519 shares 5.346 shares 29,867.446 shares 152.694 shares 5,657.332 shares 1,540.847 shares 25.828.489 shares
*+
**
8"
fli
s*
$a
**
11,458.464 shares 24,843.282 shares 39.555.356 shares 6.572.183 shares~ ~,~ ~ 6,287.381 shares 59,400.558 shares 43,143.939 shares 1,203.019 shares 61.723.588 shares
~ ~~~
Total mutual funds
(Continued)
Sehcdule
EIN: 340714775 Plan numkr: 003 Schedule H, Line 4i - Schedule ofAssels (Held at End of Yeax) December 31,2010 (el Description of investment, including maturity date, rate of intenst, collatcnl, par, or maturity value Common stock: Amaly Mwtgvge Management Inc. 2,000 s h a m Total common stock Comon/collective trusts: Principal Fixed Account Total commonlcollective trusts 14,437,995.150 shares
(b) Identity of issuer, borrower, lcsor, (a) - or similar party
(e)
(dl Cost
Current value
Participant loans
Participant loans with interest rates ranging {rum 4.25% to 10.50% and various maturity dates thmugh 2030 Total participant loans Total investments
* Party-in-Interest.
** Historicical cost information is not required on schedule H, line 4i - schedule of assets held (at md of year) for
pa~ticipantdircdcd invmhnmts.
++ Cost of participant loans is $0 as indicated in the instructions to Form 5500.

Note. This schedule IS based on informatton that has been certified as complete and accurate by Fidehty Management Trust Company, the Plan's Trustee See accompanying independent auditors' report.

University Hospitals Form 5500 Year 2010 Employee Benefit Plan

Diunggah oleh

Informasi Dokumen

Deskripsi Asli:

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

University Hospitals Form 5500 Year 2010 Employee Benefit Plan

Diunggah oleh

Hak Cipta:

Format Tersedia

Form 5500

Annual ReturnlReport of Employee Benefit Plan

OMB NOS. 1210-0110

the instructions t o the Form 5500.

This Form is Open to Public Inspection

and endlng - a multiple-employer plan; or U

This returnlreport is:

If the plan is a collectively-bargainedplan, check here. . . . . . . . . . . . . . . . . . . . . . . Check box if filing under:

0a short plan year returnlreport (less than 12 months). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,a

a DFE (specify) the final returnlreport:

Part II Basic Plan lnformation-enter l a Name of plan

special extension (enter description) all requested information

UNIVERSITY HOSPITALS HEALTH SYSTEM 403(B) MATCHED RETIREMENT SAVINGS PLAN

Three-digit plan 003 number (PN) h IC Effective date of plan 0310111996

Employer Identification Number (EIN) 34-0714775 number 216-844 1000

11100 EUCLID AVENUE CLEVELAND. OH 44106-6035

Business code (see instructions)

Form 5500 (2010)

Sponsor's name UNiVERSlTY HOSPITALS HEALTH SYSTEM

b Retired or separated participants receiving benefits............................................................................................................

C Other retired or separated participants entitled to future benefits..................... . ..................................................................

d Subtotal. Add lines 6a. 6b.and 6c........................

e Deceased participantswhose beneficiaries are receiving or are entitled to receive benefits...............................................

Total. Add lines 6d and 68......................................................................................................................................................

9a Plan funding arrangement (check all that apply)

C (Service Provider information) D (DFEIParticipating Plan Information) G (Financial Transaction Schedules)

OMB No. 1210-0110

Employee Benefits Secunb Adminirliation Pension Benefit Guaianty Cotpoation

b File as an attachment t o Form 5500.

C Plan sponsor's name as shown on line 2a of Form 5500.

D Employer Identification Number (EiN)

(b) Total amount of fees pald 37730

(b) Amount of sales and base commissions p a ~ d 0

(e) Organization code

(b) Amount of sales and base commissions paid

Fees and other commissions paid (c) Amount

(e) Organization code

-Schedule A (Form 5500) 2010 v.092308.1

Schedule A (Form 5500) 2010

(b) Amount of sales and base commissions paid

Fees and other commissions paid (d) Purpose

(e) Organization code

(b) Amount of sales and base commissions paid

Fees and other commissions paid (d) Purpose

(e) Organization code

(b) Amount of sales and base commissions paid

Fees and other commissions paid (d) Purpose

(e) Organization code

(b) Amount of sales and base commissions paid

Fees and other commissions paid (d) Purpose

(e) Organization code

(b) Amount of sales and base commissions paid

Fees and other commissions paid (d) Purpose

(e) Organization code

Schedule A (Form 5500) 2010

Investment and Annuity Contract Information

0 group deferred annuity

d Totai of balance e Deductions:

Schedule A (Form 55001 2010

Welfare Benefit Contract lnformation

Life insurance Prescription drug indemnity contract

(2) Dividends or ret

Service Provider Information