401k Plan data: 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION plan

403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION 401k Plan overview

Plan Name	403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION
Plan identification number	002

403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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(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.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

JEFFERSON HILLS CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: JEFFERSON HILLS CORPORATION

Employer identification number (EIN): 841241983

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about JEFFERSON HILLS CORPORATION

Jurisdiction of Incorporation: Colorado Department of State

Incorporation Date: 1993-09-07

Company Identification Number: 19931093247

Legal Registered Office Address: 421 ZANG ST

Lakewood
United States of America (USA)
80228

More information about JEFFERSON HILLS CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2012-01-01 KAREN YARBERRY KAREN YARBERRY 2013-10-15
002 2011-01-01 KAREN O. YARBERRY

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2012-01-01	KAREN YARBERRY		KAREN YARBERRY	2013-10-15
002	2011-01-01	KAREN O. YARBERRY

Plan Statistics for 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION

401k plan membership statisitcs for 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION

Measure Date Value
2012: 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION 2012 401k membership
Total participants, beginning-of-year 2012-01-01 474
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 178
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 30
Total of all active and inactive participants 2012-01-01 208
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 208
Number of participants with account balances 2012-01-01 158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 40
2011: 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION 2011 401k membership
Total participants, beginning-of-year 2011-01-01 477
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 159
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 315
Total of all active and inactive participants 2011-01-01 474
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 474
Number of participants with account balances 2011-01-01 214
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 11

Measure	Date	Value
2012: 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION 2012 401k membership
Total participants, beginning-of-year	2012-01-01	474
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	178
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	30
Total of all active and inactive participants	2012-01-01	208
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	208
Number of participants with account balances	2012-01-01	158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	40
2011: 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION 2011 401k membership
Total participants, beginning-of-year	2011-01-01	477
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	159
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	315
Total of all active and inactive participants	2011-01-01	474
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	474
Number of participants with account balances	2011-01-01	214
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	11

Financial Data on 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION

Measure	Date	Value
2012 : 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION 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	$453,408
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$375,407
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$369,877
Expenses. Certain deemed distributions of participant loans	2012-12-31	$664
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$263,076
Value of total assets at end of year	2012-12-31	$1,892,150
Value of total assets at beginning of year	2012-12-31	$1,814,149
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$4,866
Total interest from all sources	2012-12-31	$10,712
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$0
Was this plan covered by a fidelity bond	2012-12-31	No
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$160,807
Participant contributions at end of year	2012-12-31	$28,962
Participant contributions at beginning of year	2012-12-31	$17,564
Participant contributions at beginning of year	2012-12-31	$5,814
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	$78,001
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,892,150
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,814,149
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 registered invesment companies (eg mutual funds) at end of year	2012-12-31	$1,481,605
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$1,378,213
Interest on participant loans	2012-12-31	$639
Interest earned on other investments	2012-12-31	$10,073
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$381,583
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$408,902
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$179,620
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
Contributions received in cash from employer	2012-12-31	$102,269
Employer contributions (assets) at beginning of year	2012-12-31	$3,656
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$369,877
Contract administrator fees	2012-12-31	$4,866
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	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	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	No
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	BKD, LLP
Accountancy firm EIN	2012-12-31	440160260
2011 : 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION 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	$163,404
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$360,872
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$353,697
Expenses. Certain deemed distributions of participant loans	2011-12-31	$1,980
Value of total corrective distributions	2011-12-31	$948
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$197,924
Value of total assets at end of year	2011-12-31	$1,814,149
Value of total assets at beginning of year	2011-12-31	$2,011,617
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$4,247
Total interest from all sources	2011-12-31	$11,889
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
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
Contributions received from participants	2011-12-31	$130,119
Participant contributions at end of year	2011-12-31	$17,564
Participant contributions at beginning of year	2011-12-31	$16,748
Participant contributions at end of year	2011-12-31	$5,814
Participant contributions at beginning of year	2011-12-31	$3,483
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	$-197,468
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,814,149
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$2,011,617
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 registered invesment companies (eg mutual funds) at end of year	2011-12-31	$1,378,213
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$1,710,859
Interest on participant loans	2011-12-31	$590
Interest earned on other investments	2011-12-31	$11,299
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$408,902
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$277,728
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-46,409
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	$67,805
Employer contributions (assets) at end of year	2011-12-31	$3,656
Employer contributions (assets) at beginning of year	2011-12-31	$2,799
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$353,697
Contract administrator fees	2011-12-31	$4,247
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
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	BKD, LLP
Accountancy firm EIN	2011-12-31	440160260

Form 5500 Responses for 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION

2012: 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION 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 benefit arrangement – Insurance	Yes
2011: 403(B) THRIFT PLAN OF JEFFERSON HILLS CORPORATION 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

Insurance Providers Used on plan

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

52124

Policy instance

Insurance contract or identification number	52124
Number of Individuals Covered	378
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,741
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,913
Insurance broker organization code?	3
Insurance broker name	DUNN, MARK J

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

016494-J

Policy instance

Insurance contract or identification number	016494-J
Number of Individuals Covered	9
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

016494-J

Policy instance

Insurance contract or identification number	016494-J
Number of Individuals Covered	9
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

52124

Policy instance

Insurance contract or identification number	52124
Number of Individuals Covered	325
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,407
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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See full terms and conditions

Company Name:	JEFFERSON HILLS CORPORATION
Employer identification number (EIN):	841241983
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	Colorado Department of State
Incorporation Date:	1993-09-07
Company Identification Number:	19931093247
Legal Registered Office Address:	421 ZANG ST Lakewood United States of America (USA) 80228