401k Plan data: COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST plan

COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST 401k Plan overview

Plan Name	COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST
Plan identification number	501

COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

COLORADO FAYETTE MEDICAL CENTER has sponsored the creation of one or more 401k plans.

Company Name: COLORADO FAYETTE MEDICAL CENTER

Employer identification number (EIN): 741545266

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2012-06-01 STEVEN GULARTE
501 2011-06-01 STEVEN GULARTE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2012-06-01	STEVEN GULARTE
501	2011-06-01	STEVEN GULARTE

Plan Statistics for COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST

401k plan membership statisitcs for COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST

Measure Date Value
2012: COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST 2012 401k membership
Total participants, beginning-of-year 2012-06-01 74
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 74
Total of all active and inactive participants 2012-06-01 74
2011: COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST 2011 401k membership
Total participants, beginning-of-year 2011-06-01 74
Total number of active participants reported on line 7a of the Form 5500 2011-06-01 74
Total of all active and inactive participants 2011-06-01 74

Measure	Date	Value
2012: COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST 2012 401k membership
Total participants, beginning-of-year	2012-06-01	74
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	74
Total of all active and inactive participants	2012-06-01	74
2011: COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST 2011 401k membership
Total participants, beginning-of-year	2011-06-01	74
Total number of active participants reported on line 7a of the Form 5500	2011-06-01	74
Total of all active and inactive participants	2011-06-01	74

Financial Data on COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST

Measure	Date	Value
2013 : COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST 2013 401k financial data
Total plan liabilities at end of year	2013-05-31	$452,962
Total plan liabilities at beginning of year	2013-05-31	$452,962
Total income from all sources	2013-05-31	$0
Total plan assets at end of year	2013-05-31	$0
Total plan assets at beginning of year	2013-05-31	$0
Net plan assets at end of year (total assets less liabilities)	2013-05-31	$-452,962
Net plan assets at beginning of year (total assets less liabilities)	2013-05-31	$-452,962
2012 : COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST 2012 401k financial data
Total plan liabilities at end of year	2012-05-31	$452,962
Total income from all sources	2012-05-31	$119,734
Expenses. Total of all expenses incurred	2012-05-31	$572,696
Benefits paid (including direct rollovers)	2012-05-31	$533,657
Total plan assets at end of year	2012-05-31	$0
Total plan assets at beginning of year	2012-05-31	$0
Total contributions received or receivable from participants	2012-05-31	$10,102
Expenses. Other expenses not covered elsewhere	2012-05-31	$39,039
Net income (gross income less expenses)	2012-05-31	$-452,962
Net plan assets at end of year (total assets less liabilities)	2012-05-31	$-452,962
Net plan assets at beginning of year (total assets less liabilities)	2012-05-31	$0
Total contributions received or receivable from employer(s)	2012-05-31	$109,632

Form 5500 Responses for COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST

2012: COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	Plan funding arrangement – Trust	Yes
2012-06-01	Plan benefit arrangement - Trust	Yes
2011: COLORADO FAYETTE EMPLOYEE BENEFIT PLAN TRUST 2011 form 5500 responses
2011-06-01	Type of plan entity	Single employer plan
2011-06-01	First time form 5500 has been submitted	Yes
2011-06-01	Plan funding arrangement – Trust	Yes
2011-06-01	Plan benefit arrangement - Trust	Yes

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Company Name:	COLORADO FAYETTE MEDICAL CENTER
Employer identification number (EIN):	741545266
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)