401k Plan data: PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN plan

PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN
Plan identification number	001

PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

PACIFIC HEALTH CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: PACIFIC HEALTH CORPORATION

Employer identification number (EIN): 581557245

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about PACIFIC HEALTH CORPORATION

Jurisdiction of Incorporation: Georgia Department of States Corporations Division

Incorporation Date:

Company Identification Number: 669588

More information about PACIFIC HEALTH CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2011-01-01 APRILLE MAJOR APRILLE MAJOR 2013-06-05
001 2010-01-01 LAURA CULBERTSON
001 2009-01-01 LAURA CULBERTSON
001 2009-01-01

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2011-01-01	APRILLE MAJOR	APRILLE MAJOR	2013-06-05
001	2010-01-01	LAURA CULBERTSON
001	2009-01-01	LAURA CULBERTSON
001	2009-01-01

Plan Statistics for PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN

Measure Date Value
2011: PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,778
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,536
Number of retired or separated participants receiving benefits 2011-01-01 10
Number of other retired or separated participants entitled to future benefits 2011-01-01 341
Total of all active and inactive participants 2011-01-01 1,887
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 1,887
Number of participants with account balances 2011-01-01 701
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1,976
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1,423
Number of retired or separated participants receiving benefits 2010-01-01 13
Number of other retired or separated participants entitled to future benefits 2010-01-01 367
Total of all active and inactive participants 2010-01-01 1,803
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 1,803
Number of participants with account balances 2010-01-01 714
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,898
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,401
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 501
Total of all active and inactive participants 2009-01-01 1,902
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 1,902
Number of participants with account balances 2009-01-01 898
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,778
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,536
Number of retired or separated participants receiving benefits	2011-01-01	10
Number of other retired or separated participants entitled to future benefits	2011-01-01	341
Total of all active and inactive participants	2011-01-01	1,887
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	1,887
Number of participants with account balances	2011-01-01	701
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,976
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,423
Number of retired or separated participants receiving benefits	2010-01-01	13
Number of other retired or separated participants entitled to future benefits	2010-01-01	367
Total of all active and inactive participants	2010-01-01	1,803
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	1,803
Number of participants with account balances	2010-01-01	714
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,898
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,401
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	501
Total of all active and inactive participants	2009-01-01	1,902
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	1,902
Number of participants with account balances	2009-01-01	898
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN

Measure	Date	Value
2011 : PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
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	$1,127,228
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$1,350,375
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,258,092
Expenses. Certain deemed distributions of participant loans	2011-12-31	$14,205
Value of total corrective distributions	2011-12-31	$69,737
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$955,831
Value of total assets at end of year	2011-12-31	$13,835,161
Value of total assets at beginning of year	2011-12-31	$14,058,308
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$8,341
Total interest from all sources	2011-12-31	$265,877
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	No
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$913,897
Participant contributions at end of year	2011-12-31	$395,088
Participant contributions at beginning of year	2011-12-31	$458,713
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$41,934
Administrative expenses (other) incurred	2011-12-31	$8,341
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	$-223,147
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$13,835,161
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$14,058,308
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 registered invesment companies (eg mutual funds) at end of year	2011-12-31	$6,073,975
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$6,337,376
Interest on participant loans	2011-12-31	$13,652
Interest earned on other investments	2011-12-31	$252,225
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$7,366,098
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$7,262,219
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-94,480
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	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,258,092
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
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	RICHARD WEGLARZ CPA
Accountancy firm EIN	2011-12-31	954635567
2010 : PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$2,067,848
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$1,223,073
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,169,422
Expenses. Certain deemed distributions of participant loans	2010-12-31	$29,634
Value of total corrective distributions	2010-12-31	$14,155
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$1,002,334
Value of total assets at end of year	2010-12-31	$14,058,308
Value of total assets at beginning of year	2010-12-31	$13,213,533
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$9,862
Total interest from all sources	2010-12-31	$269,660
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$0
Was this plan covered by a fidelity bond	2010-12-31	No
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$882,801
Participant contributions at end of year	2010-12-31	$458,713
Participant contributions at beginning of year	2010-12-31	$498,933
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$115,433
Administrative expenses (other) incurred	2010-12-31	$9,862
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$844,775
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$14,058,308
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$13,213,533
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$6,337,376
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$5,748,778
Interest on participant loans	2010-12-31	$15,723
Interest earned on other investments	2010-12-31	$253,937
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$7,262,219
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$6,965,822
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$795,854
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$4,100
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,169,422
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	RICHARD WEGLARZ CPA
Accountancy firm EIN	2010-12-31	954635567
2009 : PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN

2011: PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
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 benefit arrangement – Insurance	Yes
2010: PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: PACIFIC HEALTH CORPORATION 401(K) RETIREMENT SAVINGS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	PACIFIC HEALTH CORPORATION
Employer identification number (EIN):	581557245
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	669588