401k Plan data: ST. JOHN'S VILLA, INC. 401(K) PLAN plan

ST. JOHN'S VILLA, INC. 401(K) PLAN 401k Plan overview

Plan Name	ST. JOHN'S VILLA, INC. 401(K) PLAN
Plan identification number	001

ST. JOHN'S VILLA, INC. 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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 VILLA, INC. has sponsored the creation of one or more 401k plans.

Company Name: ST. JOHNS VILLA, INC.

Employer identification number (EIN): 341671908

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST. JOHN'S VILLA, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-01-01 TAMMY BROWN 2012-09-17
001 2011-01-01 TAMMY BROWN
001 2010-01-01 TAMMY BROWN 2011-05-16
001 2009-01-01 TAMMY BROWN
001 2009-01-01 TAMMY BROWN
001 2009-01-01 TAMMY BROWN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2012-01-01	TAMMY BROWN	2012-09-17
001	2011-01-01	TAMMY BROWN
001	2010-01-01	TAMMY BROWN	2011-05-16
001	2009-01-01	TAMMY BROWN
001	2009-01-01	TAMMY BROWN
001	2009-01-01	TAMMY BROWN

Plan Statistics for ST. JOHN'S VILLA, INC. 401(K) PLAN

401k plan membership statisitcs for ST. JOHN'S VILLA, INC. 401(K) PLAN

Measure Date Value
2011: ST. JOHN'S VILLA, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 2
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 3
Total of all active and inactive participants 2011-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 5
Number of participants with account balances 2011-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: ST. JOHN'S VILLA, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 94
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 90
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 4
Total of all active and inactive participants 2009-01-01 94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 94
Number of participants with account balances 2009-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: ST. JOHN'S VILLA, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	2
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	3
Total of all active and inactive participants	2011-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	5
Number of participants with account balances	2011-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: ST. JOHN'S VILLA, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	94
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	90
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	4
Total of all active and inactive participants	2009-01-01	94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	94
Number of participants with account balances	2009-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on ST. JOHN'S VILLA, INC. 401(K) PLAN

Measure	Date	Value
2011 : ST. JOHN'S VILLA, INC. 401(K) PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$514
Total income from all sources (including contributions)	2011-12-31	$20,277
Total of all expenses incurred	2011-12-31	$111,490
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$109,584
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$22,059
Value of total assets at end of year	2011-12-31	$36,257
Value of total assets at beginning of year	2011-12-31	$126,956
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,906
Total interest from all sources	2011-12-31	$38
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$1,807
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
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$1,807
Administrative expenses professional fees incurred	2011-12-31	$1,232
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
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$20,067
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$514
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	$-91,213
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$35,743
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$126,956
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
Investment advisory and management fees	2011-12-31	$674
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$20,977
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$96,982
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$15,280
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$29,974
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$29,974
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$38
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-3,627
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	$1,992
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$109,584
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	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	REA & ASSOCIATES, INC.
Accountancy firm EIN	2011-12-31	341310124
2009 : ST. JOHN'S VILLA, INC. 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for ST. JOHN'S VILLA, INC. 401(K) PLAN

2011: ST. JOHN'S VILLA, INC. 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: ST. JOHN'S VILLA, INC. 401(K) PLAN 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	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	ST. JOHNS VILLA, INC.
Employer identification number (EIN):	341671908
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations