401k Plan data: ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN plan

ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN 401k Plan overview

Plan Name	ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN
Plan identification number	507

ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Other welfare benefit cover

401k Sponsoring company profile

SUCCESS HEALTHCARE 2, LLC has sponsored the creation of one or more 401k plans.

Company Name: SUCCESS HEALTHCARE 2, LLC

Employer identification number (EIN): 263798861

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2014-06-01 DAVID J ARMSTRONG
507 2013-06-01 DAVID ARMSTRONG
507 2012-06-01 DAVID J. ARMSTRONG, ESQ.
507 2011-06-01 DAVID J. ARMSTRONG, ESQ.

Plan id#	Filing Submission Date	Name of Administrator
507	2014-06-01	DAVID J ARMSTRONG
507	2013-06-01	DAVID ARMSTRONG
507	2012-06-01	DAVID J. ARMSTRONG, ESQ.
507	2011-06-01	DAVID J. ARMSTRONG, ESQ.

Plan Statistics for ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN

401k plan membership statisitcs for ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN

Measure Date Value
2014: ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN 2014 401k membership
Total participants, beginning-of-year 2014-06-01 462
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 0
Number of retired or separated participants receiving benefits 2014-06-01 0
Number of other retired or separated participants entitled to future benefits 2014-06-01 0
Total of all active and inactive participants 2014-06-01 0
2013: ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 481
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 462
Number of retired or separated participants receiving benefits 2013-06-01 0
Number of other retired or separated participants entitled to future benefits 2013-06-01 0
Total of all active and inactive participants 2013-06-01 462
2012: ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN 2012 401k membership
Total participants, beginning-of-year 2012-06-01 480
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 481
Total of all active and inactive participants 2012-06-01 481
Total participants 2012-06-01 481
2011: ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN 2011 401k membership
Total participants, beginning-of-year 2011-06-01 562
Total number of active participants reported on line 7a of the Form 5500 2011-06-01 480
Total of all active and inactive participants 2011-06-01 480

Measure	Date	Value
2014: ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	462
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	0
Number of retired or separated participants receiving benefits	2014-06-01	0
Number of other retired or separated participants entitled to future benefits	2014-06-01	0
Total of all active and inactive participants	2014-06-01	0
2013: ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	481
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	462
Number of retired or separated participants receiving benefits	2013-06-01	0
Number of other retired or separated participants entitled to future benefits	2013-06-01	0
Total of all active and inactive participants	2013-06-01	462
2012: ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN 2012 401k membership
Total participants, beginning-of-year	2012-06-01	480
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	481
Total of all active and inactive participants	2012-06-01	481
Total participants	2012-06-01	481
2011: ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN 2011 401k membership
Total participants, beginning-of-year	2011-06-01	562
Total number of active participants reported on line 7a of the Form 5500	2011-06-01	480
Total of all active and inactive participants	2011-06-01	480

Form 5500 Responses for ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN

2014: ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Submission has been amended	No
2014-06-01	This submission is the final filing	Yes
2014-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-06-01	Plan is a collectively bargained plan	No
2014-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Submission has been amended	No
2013-06-01	This submission is the final filing	No
2013-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-06-01	Plan is a collectively bargained plan	No
2013-06-01	Plan funding arrangement – Insurance	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes
2012: ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	Submission has been amended	Yes
2012-06-01	Plan funding arrangement – Insurance	Yes
2012-06-01	Plan benefit arrangement – Insurance	Yes
2011: ST. ALEXIUS HOSPITAL HEALTH AND DRUG PLAN 2011 form 5500 responses
2011-06-01	Type of plan entity	Single employer plan
2011-06-01	Plan funding arrangement – Insurance	Yes
2011-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number	71-60316
Policy instance	1
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number	71-60316
Policy instance	1
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number	7160316
Policy instance	1
BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )
Policy contract number	7160316
Policy instance	1

Potentially related plans

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Company Name:	SUCCESS HEALTHCARE 2, LLC
Employer identification number (EIN):	263798861
NAIC Classification:	622000
NAIC Description:	Hospitals