401k Plan data: CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN plan

CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN 401k Plan overview

Plan Name	CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN
Plan identification number	001

CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Money purchase (other than target benefit)
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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

CHARTIERS COMMUNITY MENTAL HEALTH AND RETARDATION CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: CHARTIERS COMMUNITY MENTAL HEALTH AND RETARDATION CENTER, INC.

Employer identification number (EIN): 251203882

NAIC Classification: 621420
NAIC Description: Outpatient Mental Health and Substance Abuse Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-07-01 KATHERINE L. RADAKOVICH 2014-03-17
001 2011-07-01 SUE COYLE SUE COYLE 2013-04-12
001 2009-07-01 BARBARA KARPAN BARBARA KARPAN 2011-04-11

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2012-07-01	KATHERINE L. RADAKOVICH	2014-03-17
001	2011-07-01	SUE COYLE		SUE COYLE	2013-04-12
001	2009-07-01	BARBARA KARPAN		BARBARA KARPAN	2011-04-11

Plan Statistics for CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN

401k plan membership statisitcs for CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN

Measure Date Value
2011: CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 145
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 47
Number of retired or separated participants receiving benefits 2011-07-01 0
Number of other retired or separated participants entitled to future benefits 2011-07-01 17
Total of all active and inactive participants 2011-07-01 64
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 64
Number of participants with account balances 2011-07-01 64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 0
2009: CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 119
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 133
Number of retired or separated participants receiving benefits 2009-07-01 0
Number of other retired or separated participants entitled to future benefits 2009-07-01 20
Total of all active and inactive participants 2009-07-01 153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-07-01 0
Total participants 2009-07-01 153
Number of participants with account balances 2009-07-01 122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-07-01 5

Measure	Date	Value
2011: CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	145
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	47
Number of retired or separated participants receiving benefits	2011-07-01	0
Number of other retired or separated participants entitled to future benefits	2011-07-01	17
Total of all active and inactive participants	2011-07-01	64
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	64
Number of participants with account balances	2011-07-01	64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	0
2009: CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	119
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	133
Number of retired or separated participants receiving benefits	2009-07-01	0
Number of other retired or separated participants entitled to future benefits	2009-07-01	20
Total of all active and inactive participants	2009-07-01	153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-07-01	0
Total participants	2009-07-01	153
Number of participants with account balances	2009-07-01	122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-07-01	5

Financial Data on CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN

Measure	Date	Value
2012 : CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$1,723
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$0
Total income from all sources (including contributions)	2012-06-30	$253,656
Total loss/gain on sale of assets	2012-06-30	$0
Total of all expenses incurred	2012-06-30	$2,617,974
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$2,576,026
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$168,319
Value of total assets at end of year	2012-06-30	$897,371
Value of total assets at beginning of year	2012-06-30	$3,259,966
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$41,948
Total interest from all sources	2012-06-30	$43,440
Total dividends received (eg from common stock, registered investment company shares)	2012-06-30	$52,521
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2012-06-30	$0
Total dividends received from registered investment company shares (eg mutual funds)	2012-06-30	$52,521
Was this plan covered by a fidelity bond	2012-06-30	Yes
Value of fidelity bond cover	2012-06-30	$550,000
If this is an individual account plan, was there a blackout period	2012-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-06-30	$0
Funding deficiency by the employer to the plan for this plan year	2012-06-30	$0
Minimum employer required contribution for this plan year	2012-06-30	$168,319
Amount contributed by the employer to the plan for this plan year	2012-06-30	$168,319
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-06-30	$1,726
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-06-30	$1,723
Other income not declared elsewhere	2012-06-30	$16,620
Total non interest bearing cash at end of year	2012-06-30	$112
Total non interest bearing cash at beginning of year	2012-06-30	$159
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-06-30	No
Value of net income/loss	2012-06-30	$-2,364,318
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$895,648
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$3,259,966
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-06-30	No
Were any leases to which the plan was party in default or uncollectible	2012-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-06-30	$410,269
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-06-30	$1,484,411
Interest earned on other investments	2012-06-30	$43,431
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-06-30	$19,063
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-06-30	$10,495
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-06-30	$10,495
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-06-30	$9
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-06-30	$466,201
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-06-30	$1,756,544
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-06-30	$-27,244
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-06-30	No
Was there a failure to transmit to the plan any participant contributions	2012-06-30	No
Has the plan failed to provide any benefit when due under the plan	2012-06-30	No
Contributions received in cash from employer	2012-06-30	$168,319
Employer contributions (assets) at beginning of year	2012-06-30	$8,357
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-06-30	$2,576,026
Contract administrator fees	2012-06-30	$41,948
Did the plan have assets held for investment	2012-06-30	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	2012-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2012-06-30	Disclaimer
Accountancy firm name	2012-06-30	MAHER DUESSEL CPA
Accountancy firm EIN	2012-06-30	251622758
2011 : CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$17,495
Total income from all sources (including contributions)	2011-06-30	$491,291
Total loss/gain on sale of assets	2011-06-30	$0
Total of all expenses incurred	2011-06-30	$274,723
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-06-30	$243,804
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-06-30	$194,737
Value of total assets at end of year	2011-06-30	$3,259,966
Value of total assets at beginning of year	2011-06-30	$3,060,893
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-06-30	$30,919
Total interest from all sources	2011-06-30	$58,726
Total dividends received (eg from common stock, registered investment company shares)	2011-06-30	$58,863
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-06-30	$58,863
Was this plan covered by a fidelity bond	2011-06-30	Yes
Value of fidelity bond cover	2011-06-30	$550,000
If this is an individual account plan, was there a blackout period	2011-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-06-30	$0
Funding deficiency by the employer to the plan for this plan year	2011-06-30	$0
Minimum employer required contribution for this plan year	2011-06-30	$194,737
Amount contributed by the employer to the plan for this plan year	2011-06-30	$194,737
Were there any nonexempt tranactions with any party-in-interest	2011-06-30	No
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-06-30	$26,202
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-06-30	$17,495
Total non interest bearing cash at end of year	2011-06-30	$159
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Value of net income/loss	2011-06-30	$216,568
Value of net assets at end of year (total assets less liabilities)	2011-06-30	$3,259,966
Value of net assets at beginning of year (total assets less liabilities)	2011-06-30	$3,043,398
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-06-30	No
Were any leases to which the plan was party in default or uncollectible	2011-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-06-30	$1,484,411
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-06-30	$1,133,842
Interest earned on other investments	2011-06-30	$58,725
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-06-30	$10,495
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-06-30	$1
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-06-30	$1,756,544
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-06-30	$1,892,141
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-06-30	$178,965
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-06-30	No
Was there a failure to transmit to the plan any participant contributions	2011-06-30	No
Has the plan failed to provide any benefit when due under the plan	2011-06-30	No
Contributions received in cash from employer	2011-06-30	$194,737
Employer contributions (assets) at end of year	2011-06-30	$8,357
Employer contributions (assets) at beginning of year	2011-06-30	$8,708
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-06-30	$243,804
Contract administrator fees	2011-06-30	$30,919
Did the plan have assets held for investment	2011-06-30	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	2011-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2011-06-30	Disclaimer
Accountancy firm name	2011-06-30	MAHER DUESSEL CPA
Accountancy firm EIN	2011-06-30	251622758
2010 : CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-06-30	$0
Funding deficiency by the employer to the plan for this plan year	2010-06-30	$0
Minimum employer required contribution for this plan year	2010-06-30	$198,197
Amount contributed by the employer to the plan for this plan year	2010-06-30	$198,197

Form 5500 Responses for CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN

2011: CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes
2009: CHARTIERS MENTAL HEALTH AND MENTAL RETARDATION CENTER, INC. PENSION PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan funding arrangement – Trust	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

893094-087

Policy instance

Insurance contract or identification number	893094-087
Number of Individuals Covered	50
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $11,238
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?	Yes
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

893094-087

Policy instance

Insurance contract or identification number	893094-087
Number of Individuals Covered	111
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
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?	Yes
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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Company Name:	CHARTIERS COMMUNITY MENTAL HEALTH AND RETARDATION CENTER, INC.
Employer identification number (EIN):	251203882
NAIC Classification:	621420
NAIC Description:	Outpatient Mental Health and Substance Abuse Centers