401k Plan data: FAYETTE HEALTH MANAGEMENT 401(K) PLAN plan

FAYETTE HEALTH MANAGEMENT 401(K) PLAN 401k Plan overview

Plan Name	FAYETTE HEALTH MANAGEMENT 401(K) PLAN
Plan identification number	001

FAYETTE HEALTH MANAGEMENT 401(K) 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.
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.

401k Sponsoring company profile

FAYETTE HEALTH MANAGEMENT has sponsored the creation of one or more 401k plans.

Company Name: FAYETTE HEALTH MANAGEMENT

Employer identification number (EIN): 208383875

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAYETTE HEALTH MANAGEMENT 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2011-07-01 STEVEN HANDY STEVEN HANDY 2013-03-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2011-07-01	STEVEN HANDY		STEVEN HANDY	2013-03-21

Plan Statistics for FAYETTE HEALTH MANAGEMENT 401(K) PLAN

401k plan membership statisitcs for FAYETTE HEALTH MANAGEMENT 401(K) PLAN

Measure Date Value
2011: FAYETTE HEALTH MANAGEMENT 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 149
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 51
Number of retired or separated participants receiving benefits 2011-07-01 0
Number of other retired or separated participants entitled to future benefits 2011-07-01 119
Total of all active and inactive participants 2011-07-01 170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 170
Number of participants with account balances 2011-07-01 170
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 3

Measure	Date	Value
2011: FAYETTE HEALTH MANAGEMENT 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	149
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	51
Number of retired or separated participants receiving benefits	2011-07-01	0
Number of other retired or separated participants entitled to future benefits	2011-07-01	119
Total of all active and inactive participants	2011-07-01	170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	170
Number of participants with account balances	2011-07-01	170
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	3

Financial Data on FAYETTE HEALTH MANAGEMENT 401(K) PLAN

Measure	Date	Value
2012 : FAYETTE HEALTH MANAGEMENT 401(K) PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-06-30	$720,444
Total of all expenses incurred	2012-06-30	$151,189
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$113,458
Value of total corrective distributions	2012-06-30	$17,242
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$749,611
Value of total assets at end of year	2012-06-30	$4,408,411
Value of total assets at beginning of year	2012-06-30	$3,839,156
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$20,489
Total interest from all sources	2012-06-30	$262
Total dividends received (eg from common stock, registered investment company shares)	2012-06-30	$54,916
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-06-30	$54,916
Was this plan covered by a fidelity bond	2012-06-30	Yes
Value of fidelity bond cover	2012-06-30	$1,000,000
If this is an individual account plan, was there a blackout period	2012-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Contributions received from participants	2012-06-30	$377,407
Income. Received or receivable in cash from other sources (including rollovers)	2012-06-30	$19,389
Other income not declared elsewhere	2012-06-30	$1,042
Administrative expenses (other) incurred	2012-06-30	$20,489
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-06-30	No
Value of net income/loss	2012-06-30	$569,255
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$4,408,411
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$3,839,156
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-06-30	No
Were any leases to which the plan was party in default or uncollectible	2012-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-06-30	$4,129,976
Value of interest in pooled separate accounts at beginning of year	2012-06-30	$3,459,043
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-06-30	$262
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-06-30	$118,381
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-06-30	$197,809
Net investment gain/loss from pooled separate accounts	2012-06-30	$-283,196
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-06-30	No
Was there a failure to transmit to the plan any participant contributions	2012-06-30	No
Has the plan failed to provide any benefit when due under the plan	2012-06-30	No
Contributions received in cash from employer	2012-06-30	$352,815
Employer contributions (assets) at end of year	2012-06-30	$278,435
Employer contributions (assets) at beginning of year	2012-06-30	$261,732
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-06-30	$113,458
Did the plan have assets held for investment	2012-06-30	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	2012-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2012-06-30	Disclaimer
Accountancy firm name	2012-06-30	BKD, LLP
Accountancy firm EIN	2012-06-30	440160260
2011 : FAYETTE HEALTH MANAGEMENT 401(K) PLAN 2011 401k financial data
Total income from all sources (including contributions)	2011-06-30	$1,411,860
Total of all expenses incurred	2011-06-30	$131,933
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-06-30	$114,830
Value of total corrective distributions	2011-06-30	$15,441
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-06-30	$748,585
Value of total assets at end of year	2011-06-30	$3,839,156
Value of total assets at beginning of year	2011-06-30	$2,559,229
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-06-30	$1,662
Total interest from all sources	2011-06-30	$2,941
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-06-30	No
Was this plan covered by a fidelity bond	2011-06-30	Yes
Value of fidelity bond cover	2011-06-30	$1,000,000
If this is an individual account plan, was there a blackout period	2011-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2011-06-30	No
Contributions received from participants	2011-06-30	$407,966
Income. Received or receivable in cash from other sources (including rollovers)	2011-06-30	$13
Administrative expenses (other) incurred	2011-06-30	$1,662
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Value of net income/loss	2011-06-30	$1,279,927
Value of net assets at end of year (total assets less liabilities)	2011-06-30	$3,839,156
Value of net assets at beginning of year (total assets less liabilities)	2011-06-30	$2,559,229
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-06-30	No
Were any leases to which the plan was party in default or uncollectible	2011-06-30	No
Value of interest in pooled separate accounts at end of year	2011-06-30	$3,459,043
Value of interest in pooled separate accounts at beginning of year	2011-06-30	$2,265,795
Interest earned on other investments	2011-06-30	$2,941
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-06-30	$118,381
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-06-30	$82,918
Net investment gain/loss from pooled separate accounts	2011-06-30	$660,334
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-06-30	No
Was there a failure to transmit to the plan any participant contributions	2011-06-30	No
Has the plan failed to provide any benefit when due under the plan	2011-06-30	No
Contributions received in cash from employer	2011-06-30	$340,606
Employer contributions (assets) at end of year	2011-06-30	$261,732
Employer contributions (assets) at beginning of year	2011-06-30	$210,516
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-06-30	$114,830
Did the plan have assets held for investment	2011-06-30	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	2011-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2011-06-30	Disclaimer
Accountancy firm name	2011-06-30	BKD, LLP
Accountancy firm EIN	2011-06-30	440160260

Form 5500 Responses for FAYETTE HEALTH MANAGEMENT 401(K) PLAN

2011: FAYETTE HEALTH MANAGEMENT 401(K) PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes

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Company Name:	FAYETTE HEALTH MANAGEMENT
Employer identification number (EIN):	208383875