401k Plan data: RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION plan

RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 401k Plan overview

Plan Name	RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION
Plan identification number	008

RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

ST. JOHNS RIVERSIDE HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: ST. JOHNS RIVERSIDE HOSPITAL

Employer identification number (EIN): 131740131

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
008 2012-01-01 MARC J. LEFF
008 2011-01-01 MARC J. LEFF
008 2010-01-01 PAMELA LAFRANCE
008 2009-01-01 JAMES FOY JAMES FOY 2010-07-06

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
008	2012-01-01	MARC J. LEFF
008	2011-01-01	MARC J. LEFF
008	2010-01-01	PAMELA LAFRANCE
008	2009-01-01	JAMES FOY	JAMES FOY	2010-07-06

Plan Statistics for RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION

401k plan membership statisitcs for RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION

Measure Date Value
2012: RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 2012 401k membership
Total participants, beginning-of-year 2012-01-01 404
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
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 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 0
Number of participants with account balances 2012-01-01 0
2011: RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 2011 401k membership
Total participants, beginning-of-year 2011-01-01 443
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 245
Number of retired or separated participants receiving benefits 2011-01-01 159
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 404
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 404
Number of participants with account balances 2011-01-01 404
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 2010 401k membership
Total participants, beginning-of-year 2010-01-01 463
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 264
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 179
Total of all active and inactive participants 2010-01-01 443
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 443
Number of participants with account balances 2010-01-01 443
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 3
2009: RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 2009 401k membership
Total participants, beginning-of-year 2009-01-01 479
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 275
Number of other retired or separated participants entitled to future benefits 2009-01-01 188
Total of all active and inactive participants 2009-01-01 463
Total participants 2009-01-01 463
Number of participants with account balances 2009-01-01 463

Measure	Date	Value
2012: RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 2012 401k membership
Total participants, beginning-of-year	2012-01-01	404
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
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	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	0
Number of participants with account balances	2012-01-01	0
2011: RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 2011 401k membership
Total participants, beginning-of-year	2011-01-01	443
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	245
Number of retired or separated participants receiving benefits	2011-01-01	159
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	404
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	404
Number of participants with account balances	2011-01-01	404
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 2010 401k membership
Total participants, beginning-of-year	2010-01-01	463
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	264
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	179
Total of all active and inactive participants	2010-01-01	443
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	443
Number of participants with account balances	2010-01-01	443
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	3
2009: RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 2009 401k membership
Total participants, beginning-of-year	2009-01-01	479
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	275
Number of other retired or separated participants entitled to future benefits	2009-01-01	188
Total of all active and inactive participants	2009-01-01	463
Total participants	2009-01-01	463
Number of participants with account balances	2009-01-01	463

Financial Data on RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION

Measure	Date	Value
2012 : RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$258,310
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$4,273,515
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$4,256,509
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$0
Value of total assets at end of year	2012-12-31	$0
Value of total assets at beginning of year	2012-12-31	$4,015,205
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$17,006
Total interest from all sources	2012-12-31	$56,836
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2012-12-31	$0
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$250,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Administrative expenses (other) incurred	2012-12-31	$17,006
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$-4,015,205
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$4,015,205
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$1,699,709
Interest earned on other investments	2012-12-31	$56,836
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$2,315,496
Net investment gain/loss from pooled separate accounts	2012-12-31	$201,474
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$4,256,509
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	O'CONNOR DAVIES, LLP
Accountancy firm EIN	2012-12-31	271728945
2011 : RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 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	$76,826
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$474,957
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$474,957
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	$4,015,205
Value of total assets at beginning of year	2011-12-31	$4,413,336
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	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2011-12-31	$0
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$250,000
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
Other income not declared elsewhere	2011-12-31	$71,060
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	$-398,131
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$4,015,205
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$4,413,336
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
Value of interest in pooled separate accounts at end of year	2011-12-31	$1,699,709
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$1,918,871
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$2,315,496
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$2,494,465
Net investment gain/loss from pooled separate accounts	2011-12-31	$5,766
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$474,957
Did the plan have assets held for investment	2011-12-31	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	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
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	O'CONNOR DAVIES, LLP
Accountancy firm EIN	2011-12-31	271728945
2010 : RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$341,897
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$124,978
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$124,978
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	$4,413,336
Value of total assets at beginning of year	2010-12-31	$4,196,417
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$250,000
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
Other income not declared elsewhere	2010-12-31	$78,062
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	$216,919
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$4,413,336
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$4,196,417
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
Value of interest in pooled separate accounts at end of year	2010-12-31	$1,918,871
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$1,704,669
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$2,494,465
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$2,491,748
Net investment gain/loss from pooled separate accounts	2010-12-31	$263,835
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$124,978
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
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	O'CONNOR DAVIES MUNNS & DOBBINS LLP
Accountancy firm EIN	2010-12-31	133385019

Form 5500 Responses for RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION

2012: RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 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	Yes
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 – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 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 funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: RETIREMENT PLAN FOR EMPLOYEES OF ST. JOHNS RIVERSIDE HOSPITAL PARK CARE PAVILION 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	ST. JOHNS RIVERSIDE HOSPITAL
Employer identification number (EIN):	131740131
NAIC Classification:	622000
NAIC Description:	Hospitals