401k Plan data: CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN plan

CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN
Plan identification number	520

CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CLIFTON SPRINGS HOSPITAL AND CLINIC has sponsored the creation of one or more 401k plans.

Company Name: CLIFTON SPRINGS HOSPITAL AND CLINIC

Employer identification number (EIN): 160743966

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
520 2012-01-01 KATHY BABB
520 2011-01-01 KATHY BABB
520 2010-01-01 KATHY BABB
520 2009-01-01 KATHY BABB
520 2009-01-01 KATHY BABB
520 2009-01-01 KATHY BABB

Plan id#	Filing Submission Date	Name of Administrator
520	2012-01-01	KATHY BABB
520	2011-01-01	KATHY BABB
520	2010-01-01	KATHY BABB
520	2009-01-01	KATHY BABB
520	2009-01-01	KATHY BABB
520	2009-01-01	KATHY BABB

Plan Statistics for CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN

401k plan membership statisitcs for CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN

Measure Date Value
2012: CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 691
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 599
Total of all active and inactive participants 2012-01-01 599
2011: CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 617
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 691
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 2011-01-01 691
2010: CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 585
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 617
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 617
2009: CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 588
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 585
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 0
Total of all active and inactive participants 2009-01-01 585

Measure	Date	Value
2012: CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	691
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	599
Total of all active and inactive participants	2012-01-01	599
2011: CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	617
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	691
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	691
2010: CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	585
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	617
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	617
2009: CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	588
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	585
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	0
Total of all active and inactive participants	2009-01-01	585

Form 5500 Responses for CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS PLAN

2012: CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS 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 benefit arrangement – Insurance	Yes
2011: CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS 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: CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS 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: CLIFTON SPRINGS SANITARIUM, INC. WELFARE BENEFITS 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:	CLIFTON SPRINGS HOSPITAL AND CLINIC
Employer identification number (EIN):	160743966
NAIC Classification:	622000
NAIC Description:	Hospitals