401k Plan data: RUSSELL HOSPITAL CORPORATION CRITICAL ILLNESS INSURANCE plan

RUSSELL HOSPITAL CORPORATION CRITICAL ILLNESS INSURANCE 401k Plan overview

Plan Name	RUSSELL HOSPITAL CORPORATION CRITICAL ILLNESS INSURANCE
Plan identification number	545

RUSSELL HOSPITAL CORPORATION CRITICAL ILLNESS INSURANCE Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

RUSSELL HOSPITAL CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: RUSSELL HOSPITAL CORPORATION

Employer identification number (EIN): 630385130

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RUSSELL HOSPITAL CORPORATION CRITICAL ILLNESS INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
545 2011-01-01 L.E. PEACE III

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
545	2011-01-01	L.E. PEACE III

Plan Statistics for RUSSELL HOSPITAL CORPORATION CRITICAL ILLNESS INSURANCE

401k plan membership statisitcs for RUSSELL HOSPITAL CORPORATION CRITICAL ILLNESS INSURANCE

Measure Date Value
2011: RUSSELL HOSPITAL CORPORATION CRITICAL ILLNESS INSURANCE 2011 401k membership
Total participants, beginning-of-year 2011-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4
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 4

Measure	Date	Value
2011: RUSSELL HOSPITAL CORPORATION CRITICAL ILLNESS INSURANCE 2011 401k membership
Total participants, beginning-of-year	2011-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4
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	4

Financial Data on RUSSELL HOSPITAL CORPORATION CRITICAL ILLNESS INSURANCE

Measure	Date	Value
2011 : RUSSELL HOSPITAL CORPORATION CRITICAL ILLNESS INSURANCE 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	$0
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$0
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	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$0
Total interest from all sources	2011-12-31	$0
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
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Total non interest bearing cash at end of year	2011-12-31	$0
Total non interest bearing cash at beginning of year	2011-12-31	$0
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	$0
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	$0
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
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
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	No

Form 5500 Responses for RUSSELL HOSPITAL CORPORATION CRITICAL ILLNESS INSURANCE

2011: RUSSELL HOSPITAL CORPORATION CRITICAL ILLNESS INSURANCE 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

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Company Name:	RUSSELL HOSPITAL CORPORATION
Employer identification number (EIN):	630385130
NAIC Classification:	622000
NAIC Description:	Hospitals