401k Plan data: SAINT MARYS REGIONAL MEDICAL CENTER WELFARE BENEFITS PLAN plan

SAINT MARYS REGIONAL MEDICAL CENTER WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	SAINT MARYS REGIONAL MEDICAL CENTER WELFARE BENEFITS PLAN
Plan identification number	501

SAINT MARYS REGIONAL MEDICAL CENTER WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

PRIME HEALTHCARE SERVICES RENO LLC has sponsored the creation of one or more 401k plans.

Company Name: PRIME HEALTHCARE SERVICES RENO LLC

Employer identification number (EIN): 454989022

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about PRIME HEALTHCARE SERVICES RENO LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 5134102

More information about PRIME HEALTHCARE SERVICES RENO LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAINT MARYS REGIONAL MEDICAL CENTER WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2012-07-01 MICHAEL HEATHER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2012-07-01	MICHAEL HEATHER

Plan Statistics for SAINT MARYS REGIONAL MEDICAL CENTER WELFARE BENEFITS PLAN

401k plan membership statisitcs for SAINT MARYS REGIONAL MEDICAL CENTER WELFARE BENEFITS PLAN

Measure Date Value
2012: SAINT MARYS REGIONAL MEDICAL CENTER WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 1,068
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 0
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 0
Total of all active and inactive participants 2012-07-01 0

Measure	Date	Value
2012: SAINT MARYS REGIONAL MEDICAL CENTER WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	1,068
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	0
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	0
Total of all active and inactive participants	2012-07-01	0

Form 5500 Responses for SAINT MARYS REGIONAL MEDICAL CENTER WELFARE BENEFITS PLAN

2012: SAINT MARYS REGIONAL MEDICAL CENTER WELFARE BENEFITS PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	First time form 5500 has been submitted	Yes
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	Yes
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12298135

Policy instance

Insurance contract or identification number	12298135
Number of Individuals Covered	1020
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	Yes
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

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

093678

Policy instance

Insurance contract or identification number	093678
Number of Individuals Covered	1074
Insurance policy start date	2012-07-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $21,565
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	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D AND EAP
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $215,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,565
Insurance broker organization code?	3
Insurance broker name	KEENAN & ASSOCIATES

SAINT MARYS HEALTHFIRST (National Association of Insurance Commissioners NAIC id number: 11079 )

Policy contract number

ARID0004835

Policy instance

Insurance contract or identification number	ARID0004835
Number of Individuals Covered	2547
Insurance policy start date	2012-07-01
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $5,747,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	PRIME HEALTHCARE SERVICES RENO LLC
Employer identification number (EIN):	454989022
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	5134102