401k Plan data: ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN plan

ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN 401k Plan overview

Plan Name	ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN
Plan identification number	002

ST. COLETTA OF WISCONSIN, 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. COLETTA OF WISCONSIN has sponsored the creation of one or more 401k plans.

Company Name: ST. COLETTA OF WISCONSIN

Employer identification number (EIN): 390816855

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2011-07-01 S. BUD KEMPEN
002 2010-07-01 S. BUD KEMPEN
002 2009-07-01 S. BUD KEMPEN
002 2009-07-01 S. BUD KEMPEN

Plan id#	Filing Submission Date	Name of Administrator
002	2011-07-01	S. BUD KEMPEN
002	2010-07-01	S. BUD KEMPEN
002	2009-07-01	S. BUD KEMPEN
002	2009-07-01	S. BUD KEMPEN

Plan Statistics for ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN

401k plan membership statisitcs for ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN

Measure Date Value
2011: ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 408
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 403
Number of retired or separated participants receiving benefits 2011-07-01 1
Number of other retired or separated participants entitled to future benefits 2011-07-01 18
Total of all active and inactive participants 2011-07-01 422
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 422
Number of participants with account balances 2011-07-01 229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 0
2010: ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-07-01 395
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 378
Number of retired or separated participants receiving benefits 2010-07-01 7
Number of other retired or separated participants entitled to future benefits 2010-07-01 22
Total of all active and inactive participants 2010-07-01 407
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-07-01 1
Total participants 2010-07-01 408
Number of participants with account balances 2010-07-01 234
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-07-01 0
2009: ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 449
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 379
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 18
Total of all active and inactive participants 2009-07-01 397
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-07-01 1
Total participants 2009-07-01 398
Number of participants with account balances 2009-07-01 256
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-07-01 0

Measure	Date	Value
2011: ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	408
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	403
Number of retired or separated participants receiving benefits	2011-07-01	1
Number of other retired or separated participants entitled to future benefits	2011-07-01	18
Total of all active and inactive participants	2011-07-01	422
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	422
Number of participants with account balances	2011-07-01	229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	0
2010: ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-07-01	395
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	378
Number of retired or separated participants receiving benefits	2010-07-01	7
Number of other retired or separated participants entitled to future benefits	2010-07-01	22
Total of all active and inactive participants	2010-07-01	407
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-07-01	1
Total participants	2010-07-01	408
Number of participants with account balances	2010-07-01	234
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-07-01	0
2009: ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	449
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	379
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	18
Total of all active and inactive participants	2009-07-01	397
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-07-01	1
Total participants	2009-07-01	398
Number of participants with account balances	2009-07-01	256
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-07-01	0

Financial Data on ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN

Measure	Date	Value
2012 : ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$107
Total income from all sources (including contributions)	2012-06-30	$189,337
Total of all expenses incurred	2012-06-30	$337,518
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$315,848
Expenses. Certain deemed distributions of participant loans	2012-06-30	$18,250
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$206,210
Value of total assets at end of year	2012-06-30	$1,666,091
Value of total assets at beginning of year	2012-06-30	$1,814,379
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$3,420
Total interest from all sources	2012-06-30	$419
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	No
Administrative expenses professional fees incurred	2012-06-30	$3,420
Was this plan covered by a fidelity bond	2012-06-30	Yes
Value of fidelity bond cover	2012-06-30	$500,000
If this is an individual account plan, was there a blackout period	2012-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Contributions received from participants	2012-06-30	$205,982
Participant contributions at end of year	2012-06-30	$6,526
Participant contributions at beginning of year	2012-06-30	$22,675
Participant contributions at end of year	2012-06-30	$0
Participant contributions at beginning of year	2012-06-30	$17,081
Income. Received or receivable in cash from other sources (including rollovers)	2012-06-30	$228
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-06-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-06-30	$107
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	$-148,181
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$1,666,091
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$1,814,272
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 pooled separate accounts at end of year	2012-06-30	$1,549,828
Value of interest in pooled separate accounts at beginning of year	2012-06-30	$1,705,415
Interest on participant loans	2012-06-30	$419
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-06-30	$109,737
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-06-30	$69,208
Net investment gain/loss from pooled separate accounts	2012-06-30	$-17,292
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-06-30	$315,848
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	WIPFLI LLP
Accountancy firm EIN	2012-06-30	390758449
2011 : ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$107
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$107
Total income from all sources (including contributions)	2011-06-30	$503,481
Total of all expenses incurred	2011-06-30	$222,860
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-06-30	$213,066
Expenses. Certain deemed distributions of participant loans	2011-06-30	$5,939
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-06-30	$224,570
Value of total assets at end of year	2011-06-30	$1,814,379
Value of total assets at beginning of year	2011-06-30	$1,533,758
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-06-30	$3,855
Total interest from all sources	2011-06-30	$2,908
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-06-30	No
Administrative expenses professional fees incurred	2011-06-30	$3,855
Was this plan covered by a fidelity bond	2011-06-30	Yes
Value of fidelity bond cover	2011-06-30	$500,000
If this is an individual account plan, was there a blackout period	2011-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2011-06-30	No
Contributions received from participants	2011-06-30	$220,937
Participant contributions at end of year	2011-06-30	$22,675
Participant contributions at beginning of year	2011-06-30	$3,178
Participant contributions at end of year	2011-06-30	$17,081
Participant contributions at beginning of year	2011-06-30	$8,737
Income. Received or receivable in cash from other sources (including rollovers)	2011-06-30	$3,633
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-06-30	$107
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-06-30	$107
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	$280,621
Value of net assets at end of year (total assets less liabilities)	2011-06-30	$1,814,272
Value of net assets at beginning of year (total assets less liabilities)	2011-06-30	$1,533,651
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 pooled separate accounts at end of year	2011-06-30	$1,705,415
Value of interest in pooled separate accounts at beginning of year	2011-06-30	$1,451,870
Interest on participant loans	2011-06-30	$835
Interest earned on other investments	2011-06-30	$2,073
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-06-30	$69,208
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-06-30	$69,973
Net investment gain/loss from pooled separate accounts	2011-06-30	$276,003
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	Yes
Has the plan failed to provide any benefit when due under the plan	2011-06-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-06-30	$213,066
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	WIPFLI LLP
Accountancy firm EIN	2011-06-30	390758449

Form 5500 Responses for ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN

2011: ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
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
2010: ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan funding arrangement – Trust	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement - Trust	Yes
2009: ST. COLETTA OF WISCONSIN, INC. 401(K) PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	Yes
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

Potentially related plans

ST. COLETTA EMPLOYER CONTRIBUTION PLAN [EIN = 540968224]

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Company Name:	ST. COLETTA OF WISCONSIN
Employer identification number (EIN):	390816855
NAIC Classification:	624100
NAIC Description:	Individual and Family Services