401k Plan data: PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN plan

PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN 401k Plan overview

Plan Name	PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN
Plan identification number	002

PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

PINNACLE HEALTHCARE, LLC has sponsored the creation of one or more 401k plans.

Company Name: PINNACLE HEALTHCARE, LLC

Employer identification number (EIN): 202459247

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about PINNACLE HEALTHCARE, LLC

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 2005-09-12

Company Identification Number: 1568697

Legal Registered Office Address: 1101 DEERCREEK DRIVE
-
FAIRBORN
United States of America (USA)
45324

More information about PINNACLE HEALTHCARE, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2013-01-01 HAROON ANSARI 2014-05-13 HAROON ANSARI 2014-05-13
002 2012-01-01 HAROON ANSARI NAZ
002 2011-01-01 HAROON NAZ HAROON NAZ 2012-10-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2013-01-01	HAROON ANSARI	2014-05-13	HAROON ANSARI	2014-05-13
002	2012-01-01	HAROON ANSARI NAZ
002	2011-01-01	HAROON NAZ		HAROON NAZ	2012-10-16

Plan Statistics for PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN

401k plan membership statisitcs for PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN

Measure Date Value
2012: PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 146
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 140
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 9
Total of all active and inactive participants 2012-01-01 149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 149
Number of participants with account balances 2012-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 143
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 143
Number of participants with account balances 2011-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2012: PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	146
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	140
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	9
Total of all active and inactive participants	2012-01-01	149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	149
Number of participants with account balances	2012-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	143
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	143
Number of participants with account balances	2011-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN

Measure	Date	Value
2012 : PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$84,060
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$98,924
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$92,344
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$51,246
Value of total assets at end of year	2012-12-31	$356,557
Value of total assets at beginning of year	2012-12-31	$371,421
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$6,580
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2012-12-31	$0
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$50,370
Participant contributions at end of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$1,631
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$876
Other income not declared elsewhere	2012-12-31	$32,814
Administrative expenses (other) incurred	2012-12-31	$6,580
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$-14,864
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$356,557
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$371,421
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$318,802
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$332,364
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$37,755
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$37,426
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$92,344
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	MCGLADREY LLP
Accountancy firm EIN	2012-12-31	420714325
2011 : PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets to this plan	2011-12-31	$438,530
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$54,742
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$121,851
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$112,720
Expenses. Certain deemed distributions of participant loans	2011-12-31	$4,464
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$66,977
Value of total assets at end of year	2011-12-31	$371,421
Value of total assets at beginning of year	2011-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$4,667
Total interest from all sources	2011-12-31	$11
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$62,072
Participant contributions at end of year	2011-12-31	$1,631
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$4,905
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-12-31	$2,371
Administrative expenses (other) incurred	2011-12-31	$893
Total non interest bearing cash at beginning of year	2011-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-67,109
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$371,421
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$332,364
Interest on participant loans	2011-12-31	$11
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$37,426
Net investment gain/loss from pooled separate accounts	2011-12-31	$-12,246
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$110,349
Contract administrator fees	2011-12-31	$3,774
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	MCGLADREY LLP
Accountancy firm EIN	2011-12-31	420714325

Form 5500 Responses for PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN

2012: PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PINNACLE HEALTHCARE, LLC 401(K) SAVINGS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP38037

Policy instance

Insurance contract or identification number	GP38037
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,645
Total amount of fees paid to insurance company	USD $686
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,645
Amount paid for insurance broker fees	0
Insurance broker organization code?	4
Additional information about fees paid to insurance broker	TPA SUBSIDY
Insurance broker name	PINNACLE FINANCIAL SERVICES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP38037

Policy instance

Insurance contract or identification number	GP38037
Number of Individuals Covered	20
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,772
Total amount of fees paid to insurance company	USD $626
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	PINNACLE HEALTHCARE, LLC
Employer identification number (EIN):	202459247
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	2005-09-12
Company Identification Number:	1568697
Legal Registered Office Address:	1101 DEERCREEK DRIVE - FAIRBORN United States of America (USA) 45324