401k Plan data: KADLEC HEALTH SYSTEM GROUP HEALTH PLAN plan

KADLEC HEALTH SYSTEM GROUP HEALTH PLAN 401k Plan overview

Plan Name	KADLEC HEALTH SYSTEM GROUP HEALTH PLAN
Plan identification number	501

KADLEC HEALTH SYSTEM GROUP HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Vision Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

KADLEC REGIONAL MEDICAL CENTER has sponsored the creation of one or more 401k plans.

Company Name: KADLEC REGIONAL MEDICAL CENTER

Employer identification number (EIN): 911266346

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about KADLEC REGIONAL MEDICAL CENTER

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1956-09-04

Company Identification Number: 036001542

Legal Registered Office Address: 711 CAPITOL WAY S STE 204

OLYMPIA
United States of America (USA)
985011267

More information about KADLEC REGIONAL MEDICAL CENTER

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KADLEC HEALTH SYSTEM GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2012-01-01 JEFFREY CLARK JEFFREY CLARK 2013-07-23
501 2011-01-01 JEFFREY CLARK
501 2009-10-01 SANDRA L. STEELE

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2012-01-01	JEFFREY CLARK	JEFFREY CLARK	2013-07-23
501	2011-01-01	JEFFREY CLARK
501	2009-10-01	SANDRA L. STEELE

Plan Statistics for KADLEC HEALTH SYSTEM GROUP HEALTH PLAN

401k plan membership statisitcs for KADLEC HEALTH SYSTEM GROUP HEALTH PLAN

Measure Date Value
2012: KADLEC HEALTH SYSTEM GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,902
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,910
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 1,910
2011: KADLEC HEALTH SYSTEM GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2,344
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 3,101
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 3,101
Total participants 2011-01-01 3,101
2009: KADLEC HEALTH SYSTEM GROUP HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 134
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 190
Number of retired or separated participants receiving benefits 2009-10-01 0
Number of other retired or separated participants entitled to future benefits 2009-10-01 0
Total of all active and inactive participants 2009-10-01 190

Measure	Date	Value
2012: KADLEC HEALTH SYSTEM GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,902
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,910
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	1,910
2011: KADLEC HEALTH SYSTEM GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2,344
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	3,101
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	3,101
Total participants	2011-01-01	3,101
2009: KADLEC HEALTH SYSTEM GROUP HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	134
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	190
Number of retired or separated participants receiving benefits	2009-10-01	0
Number of other retired or separated participants entitled to future benefits	2009-10-01	0
Total of all active and inactive participants	2009-10-01	190

Form 5500 Responses for KADLEC HEALTH SYSTEM GROUP HEALTH PLAN

2012: KADLEC HEALTH SYSTEM GROUP HEALTH PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: KADLEC HEALTH SYSTEM GROUP HEALTH PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
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 funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: KADLEC HEALTH SYSTEM GROUP HEALTH PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	First time form 5500 has been submitted	Yes
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	KADLEC REGIONAL MEDICAL CENTER
Employer identification number (EIN):	911266346
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1956-09-04
Company Identification Number:	036001542
Legal Registered Office Address:	711 CAPITOL WAY S STE 204 OLYMPIA United States of America (USA) 985011267