401k Plan data: HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN plan

HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN 401k Plan overview

Plan Name	HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN
Plan identification number	002

HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
Cash balance or similar plan - Plan has a "cash balance" formula. For this purpose, a "cash balance" formula is a benefit formula in a defined benefit plan by whatever name (for example, personal account plan, pension equity plan, life cycle plan, cash account plan, etc.) that rather than, or in addition to, expressing the accrued benefit as a life annuity commencing at normal retirement age, defines benefits for each employee in terms more common to a defined contribution plan such as a single sum distribution amount (for example, 10 percent of final average pay times years of service, or the amount of the employee's hypothetical account balance).
Covered by PBGC - Plan is covered under the PBGC insurance program (see ERISA section 4021).

401k Sponsoring company profile

HORIZON HEALTHCARE SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: HORIZON HEALTHCARE SERVICES, INC.

Employer identification number (EIN): 220999690

NAIC Classification: 524140

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2011-01-01 CYNTHIA TOBIA CYNTHIA TOBIA 2012-10-15
002 2009-01-01 CYNTHIA M. TOBIA CYNTHIA M. TOBIA 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2011-01-01	CYNTHIA TOBIA		CYNTHIA TOBIA	2012-10-15
002	2009-01-01	CYNTHIA M. TOBIA		CYNTHIA M. TOBIA	2010-10-14

Plan Statistics for HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN

401k plan membership statisitcs for HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN

Measure Date Value
2011: HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2,970
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 0
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 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 0
2009: HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 2,892
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,161
Number of retired or separated participants receiving benefits 2009-01-01 134
Number of other retired or separated participants entitled to future benefits 2009-01-01 1,457
Total of all active and inactive participants 2009-01-01 2,752
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 2
Total participants 2009-01-01 2,754
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 93

Measure	Date	Value
2011: HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2,970
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	0
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	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	0
2009: HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	2,892
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,161
Number of retired or separated participants receiving benefits	2009-01-01	134
Number of other retired or separated participants entitled to future benefits	2009-01-01	1,457
Total of all active and inactive participants	2009-01-01	2,752
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	2
Total participants	2009-01-01	2,754
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	93

Financial Data on HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN

Measure	Date	Value
2011 : HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$-184,918
Total unrealized appreciation/depreciation of assets	2011-12-31	$-184,918
Total transfer of assets from this plan	2011-12-31	$62,219,489
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	$966,188
Total income from all sources (including contributions)	2011-12-31	$5,455,671
Total loss/gain on sale of assets	2011-12-31	$14,197
Total of all expenses incurred	2011-12-31	$3,950,906
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$3,090,937
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$0
Value of total assets at end of year	2011-12-31	$0
Value of total assets at beginning of year	2011-12-31	$61,680,912
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$859,969
Total interest from all sources	2011-12-31	$205
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$1,972,750
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$1,953,622
Administrative expenses professional fees incurred	2011-12-31	$620,484
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$100,000,000
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
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$137,112
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$885,981
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$810,733
Other income not declared elsewhere	2011-12-31	$20,405
Administrative expenses (other) incurred	2011-12-31	$101,352
Liabilities. Value of operating payables at beginning of year	2011-12-31	$155,455
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	$1,504,765
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$60,714,724
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
Investment advisory and management fees	2011-12-31	$138,133
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$59,275,701
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$251,679
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$251,679
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$205
Asset value of US Government securities at beginning of year	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$3,633,032
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
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
Income. Dividends from common stock	2011-12-31	$19,128
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$3,090,937
Asset. Corporate debt instrument debt (other) at beginning of year	2011-12-31	$0
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
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-12-31	$1,130,439
Did the plan have assets held for investment	2011-12-31	No
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	Yes
Aggregate proceeds on sale of assets	2011-12-31	$7,036,843
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$7,022,646
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	WITHUM SMITH & BROWN, PC
Accountancy firm EIN	2011-12-31	222027092
2010 : HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$264,559
Total unrealized appreciation/depreciation of assets	2010-12-31	$264,559
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$966,188
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$471,678
Total income from all sources (including contributions)	2010-12-31	$7,250,108
Total loss/gain on sale of assets	2010-12-31	$275,369
Total of all expenses incurred	2010-12-31	$5,275,227
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$4,463,308
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$0
Value of total assets at end of year	2010-12-31	$61,680,912
Value of total assets at beginning of year	2010-12-31	$59,211,521
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$811,919
Total interest from all sources	2010-12-31	$148,726
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$1,882,776
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$1,863,016
Administrative expenses professional fees incurred	2010-12-31	$570,021
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$100,000,000
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
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$137,112
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$781,511
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$885,981
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$573,642
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$810,733
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$471,678
Other income not declared elsewhere	2010-12-31	$39,639
Liabilities. Value of operating payables at end of year	2010-12-31	$155,455
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	$1,974,881
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$60,714,724
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$58,739,843
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
Investment advisory and management fees	2010-12-31	$200,208
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$59,275,701
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$34,044,387
Interest earned on other investments	2010-12-31	$26,961
Income. Interest from US Government securities	2010-12-31	$39,046
Income. Interest from corporate debt instruments	2010-12-31	$81,974
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$251,679
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$551,769
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$551,769
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$745
Asset value of US Government securities at end of year	2010-12-31	$0
Asset value of US Government securities at beginning of year	2010-12-31	$8,278,371
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$4,639,039
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
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
Income. Dividends from common stock	2010-12-31	$19,760
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$4,463,308
Asset. Corporate debt instrument debt (other) at end of year	2010-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2010-12-31	$11,186,502
Contract administrator fees	2010-12-31	$41,690
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
Assets. Corporate common stocks other than exployer securities at end of year	2010-12-31	$1,130,439
Assets. Corporate common stocks other than exployer securities at beginning of year	2010-12-31	$3,795,339
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
Aggregate proceeds on sale of assets	2010-12-31	$40,819,793
Aggregate carrying amount (costs) on sale of assets	2010-12-31	$40,544,424
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	WITHUM SMITH & BROWN, PC
Accountancy firm EIN	2010-12-31	222027092
2009 : HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT 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 HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN

2011: HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT 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	Yes
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	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: HORIZON BLUE CROSS BLUE SHIELD OF NJ UNION EMPLOYEES RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
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	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	HORIZON HEALTHCARE SERVICES, INC.
Employer identification number (EIN):	220999690
NAIC Classification:	524140